Why This Role is Important to Us The Community Nurse, reporting to a Clinical Manager, works with residents in designated housing properties and provides residents with health education and coaching focused on self care management, wellness, and care coordination. The residents can be members of any health plan. The Community Nurse will use their clinical skills, educatio

Why This Role is Important to Us The Sr. Director of Internal Audit position is a key member of the Commonwealth Care Alliance's Internal Audit team responsible for the successful completion of external regulatory compliance audits including, external regulatory compliance audits. The position advises the Audit and Compliance leadership on key risks, provides directions t

Under the supervision of the Enrollment Director, the Supervisor, Enrollment provides leadership for, and direct supervision of, the Enrollment Specialists, Retention Specialists, and Reconciliation Specialists. They are responsible for overall day to day operations of the Enrollment department, ensuring accurate processing and maintenance of membership enrollment records

Under the supervision of the Enrollment Director, the Supervisor, Enrollment provides leadership for, and direct supervision of, the Enrollment Specialists, Retention Specialists, and Reconciliation Specialists. They are responsible for overall day to day operations of the Enrollment department, ensuring accurate processing and maintenance of membership enrollment records

Why This Role is Important to Us To promote Commonwealth Care Alliance's (CCA) and CCA CA health products to individuals, responsible parties, and groups at a variety of settings. Responsible for executing our marketing and enrollment strategies, cultivating relationships with contracted sites and health providers (CA), community organizations, senior centers, and elderly

Why This Role is Important to Us The Clinical Director, Hospital to Home, is responsible for leading CCA's engagement with acute care hospitals and developing strategies and partnerships to support CCA members through transitions across care settings. The position provides supervision and leadership to a team of facility based providers (medical and behavioral health) as

Member Contact Center Provider Contact Center Contact Center Training and Quality Member Communications Consumer Experience Operational functions Corporate Ombudsman and Service Recovery Programs Enterprise wide Project Leadership (ad hoc) Working Conditions Standard office conditions. What We're Looking For Education Required Bachelor's Degree or equivalent experience Ed

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

Why This Role is Important to Us The Senior Manager, IT Quality Assurance is part of the Business Solutions team responsible for QA testing, product management and solutions delivery. This role is the primary owner for the QA Managed Services program and will be critical in the definition and implementation of our Enterprise QA program to supports CCA's ability to serve o

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

The FWA Investigator Coder Sr. Associate is an integral part of the Fraud, Waste & Abuse (FWA) Special Investigation Unit (SIU). The position reports directly to the Sr. Director, Fraud, Waste & Abuse. This position utilizes a variety of FWA investigative tools and techniques to complete activities required to identify compliance with state and federal results, regulation

Why This Role is Important to Us The Privacy Analyst 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 develo

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a

Reporting to the VP Quality & Controls Assurance, the incumbent is responsible for independent quality reviews of medical claims, and evaluating Call Center activities for compliance with policies and Standard Operating Procedures (SOP). Additionally, this role will review issuance of ID Cards, and Welcome Kits for accuracy. This role will also conduct reviews to verify a