- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the ... of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited… more
- Commonwealth Care Alliance (Boston, MA)
- …development, and maintenance of data systems and tools that support Commonwealth Care Alliance's (CCA) risk adjustment and Hierarchical Condition Category (HCC) ... ability to work independently or in team settings. + Prior experience working with EDPS data flows and Medicare...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
- Commonwealth Care Alliance (Boston, MA)
- …member appointments, transportation, translation, and interpretation services. * Initiates prior authorization intake process. * Assist in resolving member billing ... , health plan, insurance or government is preferred. * Prior experience working in the health care industry front...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
- Commonwealth Care Alliance (Boston, MA)
- …the process for evaluating the effectiveness of company medical policies and prior authorization programs and supports the evaluation of payment policies. They ... in the annual evaluation of the effectiveness of company medical policies and prior authorization program. + Support the payment policy and claims teams in the… more
- Commonwealth Care Alliance (Boston, MA)
- …the process for evaluating the effectiveness of company medical policies and prior authorization programs and supports the evaluation of payment policies. They ... Facilitate the annual evaluation of the effectiveness of company medical policies and prior authorization program. + Support the payment policy and claims teams in… more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited ... Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical records… more
- Commonwealth Care Alliance (Boston, MA)
- …participant, care giver or provider accommodations or interpreter needs are secured prior to meeting** **Share and present outcomes of Committee meetings that ... an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for… more
- Commonwealth Care Alliance (Boston, MA)
- …a managed care environment is strongly preferred. + Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in ... an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for… more
- Commonwealth Care Alliance (Boston, MA)
- …as Facets, QNXT, or Amisys. **Desired Experience (nice to have):** + Prior experience working with MassHealth and Medicare Advantage reimbursement rules is strongly ... an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for… more
- Tufts Medicine (Lowell, MA)
- …program + Current license as a Physician Assistant or Nurse Practitioner in the Commonwealth of Massachusetts + Prior advanced heart failure or acute care ... experience preferred. + Current certification in CPR required + A team player who is excited to work cooperatively with a wide range of stakeholders and disciplines to champions world class patient satisfaction and support **How to apply:** You can submit an… more
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