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Director, Medicare Compliance - Remote
Commonwealth Care Alliance
-
Boston, MA
Why This Role is Important to Us The Director of Regulatory Compliance works directly with the Vice President Health Plan Regulatory Compliance/National Medicare Compliance Officer to develop and maintain an effective Health Plan Regulatory Compliance Program. This position is responsible for leading the development, implementation, and ongoing maintenance of elements of
Email Job
Posted Today
Sr. Manager, Medicare Compliance - Remote
Commonwealth Care Alliance
-
Boston, MA
System Administrator for GRC System System Administrator for GRC System Develop reports within the system for distribution among the organization Identify and scope needed system enhancements Work with vendor to correct identified issues Oversee the development and maintenance of system process documentation Work with training specialist to develop user tools Become subje
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Posted Today
Sr. Analyst, Medicare Compliance - Remote
Commonwealth Care Alliance
-
Boston, MA
Why This Role is Important to Us The primary focus areas of this position is managing compliance issues and regulatory responses including Corrective Action Plan (CAP) monitoring, investigations, validation activities, and issue management. Support the organization with assistance in interpreting regulations and providing education. Supervision Exercised No, this position
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Posted Today
SVP, Internal Audit & Enterprise Risk Management - (Remote)
Commonwealth Care Alliance
-
Boston, MA
Why This Role is Important to Us The Senior Vice President, Internal Audit & Enterprise Risk Management (Remote) will lead the company's Internal Audit Program and activities as well as the organization's Enterprise Risk Management (ERM) Program and activities. The Internal Audit Program will employ a risk based approach in focusing audit resources on the highest risks wh
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Posted Today
VP, Quality & Controls Assurance (Remote)
Commonwealth Care Alliance
-
Boston, MA
Why This Role is Important to Us The Vice President, Quality & Controls Assurance reports to compliance leadership, and strategically and operationally leads various quality reviews of claims, Hierarchical Condition Categories (HCC) and clinical coding, call monitoring, system technology upgrades, and other critical compliance/financial/operational controls and processes
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Posted 1 day ago
Marketing Data Manager
Commonwealth Care Alliance
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Boston, MA
Why This Role is Important to Us We are seeking a highly skilled and data driven Marketing Data Manager to join our Marketing Department. This new role will be integral to the success of our health plan's marketing initiatives. As a Marketing Data Manager, you will be responsible for managing and analyzing marketing data to drive decision making and optimize marketing str
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Posted 1 day ago
Remote - Sr. Analyst, Privacy
Commonwealth Care Alliance
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Boston, MA
Why This Role is Important to Us The Sr. Analyst, Privacy will play a key role in building, operationalizing and sustaining an effective and robust Privacy Program. Reporting to the Manager, 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 d
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Posted 2 days ago
Supervisor, Member Services - Remote
Commonwealth Care Alliance
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Boston, MA
Adhere to all applicable compliance requirements and the Code of Conduct. Secondary Responsibilities Influence operational priorities Execution of day to day activities Solid functional expertise What We're Looking For Bachelor's Degree or equivalent experience 3 5 years experience Previous call center experience Managerial experience English, bilingual preferred
Email Job
Posted 3 days ago
Provider Directory Manager (Remote)
Commonwealth Care Alliance
-
Boston, MA
Why This Role is Important to Us Reporting to the Manager, Credentialing & Provider Data, the Provider Directory Manager will perform advanced technical provider directory services work within CCA. It will be the responsibility of the manager to conduct UAT and data analysis on a recurring basis to ensure data accuracy across all lines of business and markets. They will w
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Posted 3 days ago
Supervisor, Health Information Management (Remote)
Commonwealth Care Alliance
-
Boston, MA
The Health Information Management (HIM) Supervisor is responsible for the daily planning and monitoring of department operations, staffing and coordinating tasks to ensure timely completion to meet regulatory requirements at CCA. Supervision Exercised Yes, which includes but is not limited to providing leadership, work direction, and performance feedback to subordinate st
Email Job
Posted 3 days ago
HIM Specialist (Part Time) (Remote)
Commonwealth Care Alliance
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Boston, MA
Why This Role is Important to Us Under the guidance of the Manager of Health Information Management, the HIM Specialist I is responsible for following processes to ensure compliant release of records, request for records and accurate data entry into CCA's Electronic Medical Record (EMR) Request and review EMR from partnering organizations to obtain pertinent member docume
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Posted 3 days ago
Virtual Medical Control Provider
Commonwealth Care Alliance
-
Boston, MA
Why This Role is Important to Us The instED Virtual Medical Control Physician is a specially trained physician that provides remote monitoring and clinical direction in support of high quality, convenient, and cost effective advanced urgent care within the home in order to prevent avoidable Emergency Department utilization. This is a part time position. 6 12 hour shifts,
Email Job
Posted 4 days ago
Sr. Medical Director, instED
Commonwealth Care Alliance
-
Boston, MA
Support and manage team of 23+ Virtual Medical Control (VMC) clinicians, made up of physicians (EM/FM/IM) and NPs, especially staffing, scheduling, recruiting, and overseeing quality of care and professionalism. Recruit, hire, onboard, and coach new VMCs clinicians as our operations continue to grow. Using a data driven staffing management system, optimize staffing to sup
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Posted 4 days ago
Manager MA/RI Network Quality and CCA Provider and Facility Quality & Safety
Commonwealth Care Alliance
-
Boston, MA
Why This Role is Important to Us Reporting to the Sr Director, Quality Performance and Value Based Care, the Provider and Facility Quality & Safety Manager is responsible for designing and executing quality measurement and improvement programs and is responsible for managing and implementing key population health and network quality initiatives to achieve high performance
Email Job
Posted 4 days ago
Temporary LTSS Service Authorization Specialist
Commonwealth Care Alliance
-
Boston, MA
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 LTSS Service Authorization Specialist is respons
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Posted 4 days ago
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