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

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

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

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

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

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

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

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,

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

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

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann

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

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

Why This Role is Important to Us The Provider Enrollment Specialist facilitates the paperwork and timely follow through of all required CCA and CCC employed clinician licenses, registrations, hospital affiliations and insurance enrollments including, but not limited to, state license, DEA & MCSR renewals, NPI registration, CAQH applications, Medicare & MassHealth enrollme

Why This Role is Important to Us The Senior Director, Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and Risk Operations, and leads the Third Party Compliance Oversight department for Commonwealth Care Alliance (CCA). This position effectively leads our Third Party Compliance Oversight programs which includes monitoring and eva