- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA -Auth & Utilization Mgmt **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be ... **This position is intended to be a liaison for CCA members and provide care coordination support for ...CCA members and provide care coordination support for CCA members admitted to behavioral health facilities including inpatient… more
- Commonwealth Care Alliance (Boston, MA)
- 024040 Clin Alli-HICM Position Summary: Commonwealth Care Alliance's ( CCA ) Community Intensive Care (CIC) program is responsible for providing care delivery and care ... of high risk and complex people. This panel of CCA 's patients incorporates the care of individuals with significant...function of the CICRN role is delivering care to CCA 's most complex patients, providing care management and care… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA -Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's ( CCA ) Clinical Effectiveness (Authorization) Unit is primarily responsible for ... care services, procedures, and facilities under the provisions of CCA 's benefits plan. The Utilization Management (UM) Reviewer is...Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of… more
- Commonwealth Care Alliance (Boston, MA)
- 013560 CCA -Clin Informatics & Sys Dev **Position Summary** The Clinical Informaticist is a Registered Nurse, clinician or individual experienced in working in ... clinical platforms but also in the Clinical responsibilities and workflows of CCA 's unique Model of Care, the Clinical Informaticist coordinates with their manager… more
- Commonwealth Care Alliance (Boston, MA)
- …impacts on members and caregivers and care coordination to a defined panel of CCA member's needs. The panel of members will be comprised of individuals with serious ... patients in the Community Intensive Care Program. Commonwealth Care Alliance's ( CCA ) Community Intensive Care (CIC) programing is responsible for providing care… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA -Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the Appeals and ... Schedule Peer to Peer calls between requesting MDs and CCA MDs, per NCQA requirements. + Coordinate BOH hearings...and improve quality of operations. + Act as a CCA content expert on State and Federal Grievance and… more
- Commonwealth Care Alliance (Boston, MA)
- …Specialist is the primary contact for members as they transition to a CCA health plan. The Specialist contacts new members via telephonic outreach and identifies ... that member needs are addressed through liaising with internal CCA providers and external healthcare providers. The Specialist also...members + Orients new members to the value of CCA as their health plan, providing education, answering members'… more
- Commonwealth Care Alliance (Worcester, MA)
- …Clin Alli-Clin Assessment & CP **Position Summary:** Commonwealth Care Alliance's ( CCA ) Assessment unit conducts initial and ongoing face-to-face assessments for ... CCA enrollees. The Unit is also responsible for evaluating...to support timely interventions designed to improve outcomes for CCA members. The Assessment nurse reports to the Regional… more
- Commonwealth Care Alliance (Boston, MA)
- 013390 CCA -Clinical Performance **Position Summary:** The Director of Clinical Performance Improvement, reporting to the Sr Director, Clinical Operations and ... + Identify the most appropriate and accurate benchmarks for CCA 's populations and health plan products as it relates...scan the market for new benchmakrs and targets for CCA . + Through the use of established reporting, analytics,… more
- Commonwealth Care Alliance (Boston, MA)
- 024450 Clin Alli-Care Management **Position Summary:** Commonwealth Care Alliance's ( CCA ) Clinical Care Manager is a registered nurse or other independently licensed ... dyad, the Clinical Care Manager works directly with assigned CCA members to help them navigate the health care...+ Must be able to come to the local CCA office and/or provider offices for various meetings as… more