• Palliative Care RN, North of Boston

    Commonwealth Care Alliance (Wakefield, MA)
    023540 Clin Alli-Palliative Care **Position Summary:** Commonwealth Care Alliance's (CCA)Palliative Care Team, comprised of multi-disciplinary clinicians, will ... individuals with significant medical, behavioral, and social complexities that require intensive support . The Palliative teams will reside at CCA's state - wide… more
    Commonwealth Care Alliance (06/02/25)
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  • BH Utilization Review Clinician

    Commonwealth Care Alliance (Boston, MA)
    …of care and assist with transition of care planning and coordination when a Commonwealth Care Alliance clinician is not already involved. Work with ESPs to ensure ... and level of care based on the consistent application of decision support tools, and communicate decisions to facility, providers, treatment team and member.… more
    Commonwealth Care Alliance (05/21/25)
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  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    …the member experience. This position works collaboratively across many departments at Commonwealth Care Alliance (CCA) as well as externally to facilitate timely ... and member outreach related to the member complaint. + Support creation, review, and mailing of notices to members...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
    Commonwealth Care Alliance (05/21/25)
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  • Sr. Care Coordinator, Leominster Area

    Commonwealth Care Alliance (Worcester, MA)
    …creating a member-centered care plan and helping members access a broad base of support in the care team to advance their goals for independent living, recovery, and ... position requires in person visits to members in their homes and will support members across various locations **Supervision Exercised:** + No, this position does… more
    Commonwealth Care Alliance (06/01/25)
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  • Appeals & Grievances Program Advisor

    Commonwealth Care Alliance (Boston, MA)
    …This position works collaboratively with the AG Representatives and Management to support the development and maintenance of a quality program. This position will ... and areas on noncompliance. In addition to NCQA program support , this role will also support compliance...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
    Commonwealth Care Alliance (05/21/25)
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  • Manager, Medical Policy

    Commonwealth Care Alliance (Boston, MA)
    …Medical Director of medical policy, manage the expansion the MP team to support the company's geographic and business expansions, including the centralization of all ... medical policy development,review and dissemination processes. + Support internal business areas in the development, annual review and implementation of policies and… more
    Commonwealth Care Alliance (05/31/25)
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  • Medicare/Medicaid Claims Reimbursement Analyst

    Commonwealth Care Alliance (Boston, MA)
    …audit, compliance, and provider engagement initiatives. This role also provides support in managing provider disputes and escalations requiring detailed pricing and ... regulations, and CMS payment methodologies (eg, DRG, APC, RBRVS). + Support provider appeal reviews and internal payment integrity investigations by providing… more
    Commonwealth Care Alliance (05/31/25)
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  • Durable Medical Equipment Coordinator (Part-time)

    Commonwealth Care Alliance (Boston, MA)
    …development and maintenance of supporting Excel file and/or other tracking system to support DME coordination and data needs. + Responsible for ensuring that all DME ... appropriately to each patient chart. + Provide training and support on the Tomorrow Health system to CCA Primary...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
    Commonwealth Care Alliance (06/02/25)
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  • Medical Policy Program Manager

    Commonwealth Care Alliance (Boston, MA)
    …Hub Team on the annual review of all existing Medical Policies. + Support internal business areas in the development, annual review and implementation of policies ... of company medical policies and prior authorization program. + Support the payment policy and claims teams in the...and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants… more
    Commonwealth Care Alliance (05/31/25)
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  • Medicare/Medicaid Claims Editing Specialist

    Commonwealth Care Alliance (Boston, MA)
    …user acceptance testing, and analyze post production reports for issues + Support collaboration between PI/Claims and other internal stakeholders related to the ... to set priorities, build partnerships, meet internal customer needs, and obtain support for department initiatives + Ability to plan, organize, and manage own… more
    Commonwealth Care Alliance (05/28/25)
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