Why This Role is Important to Us The Lead Software Engineer leads software engineers in the development and support/maintenance of software solutions, including but not limited to integrations, web applications and services, API, ETL processes, batch, and/or job orchestration spanning all systems and functional areas (such as clinical, claims, enrollment, reporting, finan

Why This Role is Important to Us The Sr. Associate, Executive IT Support provides concierge level desktop and mobile support to empower and enable CCA executives and their admins to work optimally. This highly visible role must meet enhanced service levels including 24/7 availability (Monday Friday) to resolve issues and provide implementation, maintenance, and end user s

Why This Role is Important to Us The Lead Software Engineer leads software engineers in the development and support/maintenance of software solutions, including but not limited to integrations, web applications and services, API, ETL processes, batch, and/or job orchestration spanning all systems and functional areas (such as clinical, claims, enrollment, reporting, finan

Why This Role is Important to Us Reporting to the Health Plan Chief Medical Officer (CMO), the Massachusetts and Rhode Island Market Medical Director is an integral part of a mission driven clinical and market team. The Medical Director's primary responsibilities are to ensure that the clinical processes that contribute to the Massachusetts Duals (SCO/OneCare) and RI DSNP

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsi

Why This Role is Important to Us The Provider Relations Specialist is responsible for cultivating, maintaining and strengthening relationships with the Commonwealth Care Alliance's (CCA) provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including primary care practices, sp

Why This Role is Important to Us The Nurse Utilization Management (UM) Reviewer is responsible for day to day timely clinical and service authorization review for medical necessity and decision making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and organizational determinations.

Respond and effectively triage member phone calls in order to accurately and timely route to appropriate area Work with care management team to address the needs of members, caregivers and other CCA constituents Provide timely and accurate information regarding member benefits and services including Continuity of Care Meticulously document all member and prospective membe

Why This Role is Important to Us Under direction of the Compliance Manager, , the primary focus of this position is the day to day coordination of oversight activities for CCA's First Tier, Downstream, Related Entities (FDR) and Medicaid Material Subcontractors (MS), also known as the FDR MS Program. This includes review of contract and policy documents, coordinating atte

Why This Role is Important to Us This is a key leadership role that will provide oversight of CCA's multi state Mail Operations. The Mail Operations Manager is responsible for being CCA's subject matter expert for all postage and mailing activities. The Mail Operations Manager ensures compliance with business requirements and with all US Postal Service regulations on post

Why This Role is Important to Us The Executive Administrator will serve as a critical contributor to the workings of the Chief Revenue and Growth officer and his direct reports including the connection and management of many critical components of the organization. In addition, the Executive Administrator will support the General Manager, Market Lead Massachusetts. What Y

Why This Role is Important to Us The Manager, Privacy will play a key role in building, operationalizing and sustaining an effective and robust Privacy Program. Reporting to the Director, the role will ensure that the organization complies with relevant and applicable privacy laws, regulations, contractual requirements, and standards. The role will be responsible for deve

Why This Role is Important to Us The Director, Privacy will play a key role in building, operationalizing and sustaining an effective and robust Privacy Program. Reporting to the Chief Privacy Officer, the role will ensure that the organization complies with relevant and applicable privacy laws, regulations, contractual requirements, and standards. The role will be respon

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Service Authorization Specialist is responsible