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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 5 days ago
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
Email Job
Posted 5 days ago
Provider Engagement Quality Specialist - ACO/PO
Commonwealth Care Alliance
-
Farmington Hills, MI
Why This Role is Important to Us The Specialist, Quality Provider Engagement ACO/PO monitors Quality Measures within Accountable Care Organization physicians' offices for Group Practice Reporting Options (GPRO). Conducts onsite reviews and audits for Medicare compliance. This position partners with providers to support in office improvement efforts aimed at increasing the
Email Job
Posted 20 days ago
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
Email Job
Posted 5 days ago
Provider Contract Manager
Commonwealth Care Alliance
-
Farmington Hills, MI
Why This Role is Important to Us The Provider Contract Manager is responsible for developing, negotiating and managing contractual, legal and financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost effective providers of healthcare services. What You'll Be Doing Develop, negotiate and maintain provider contracts for
Email Job
Posted 22 days ago
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
Email Job
Posted 6 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 8 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
Email Job
Posted 8 days ago
Supervisor, Health Information Management (Remote)
Commonwealth Care Alliance
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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 8 days ago
HIM Specialist (Part Time) (Remote)
Commonwealth Care Alliance
-
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
Email Job
Posted 8 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 9 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
Email Job
Posted 9 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 9 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
Email Job
Posted 9 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
Email Job
Posted 9 days ago
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