• Sr. Care Coordinator, Fall River/New Bedford Area

    Commonwealth Care Alliance (Boston, MA)
    …part of the care management dyad, the Care Coordinator works directly with assigned CCA members to help them navigate the health care system, ensures the members ... & Responsibilities:** + Maintains open lines of communication with CCA members and interact with members as needed, based...Record, in an effective manner while strictly adhering to CCA policies and procedures. + Utilizing and depending on… more
    Commonwealth Care Alliance (05/23/25)
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  • Care Delivery RN Admissions Coordinator

    Commonwealth Care Alliance (Boston, MA)
    023540 Clin Alli-Palliative Care Position Summary: Commonwealth Care Alliance's ( CCA ) Care Delivery service lines are responsible for providing care delivery and ... of high risk and complex people. This panel of CCA 's patients incorporates the care of individuals with significant...Health Plan Referrals and Palliative Smart List to review CCA Health Plan members identified with Care Delivery needs… more
    Commonwealth Care Alliance (07/04/25)
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  • Medical Policy Director

    Commonwealth Care Alliance (Boston, MA)
    011200 CCA -Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management (UM) and Policy, the Medical Policy ... and social determinants of health services specific to the population serviced by CCA . The Medical Policy Director is an independent contributor who works in… more
    Commonwealth Care Alliance (05/31/25)
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  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA -Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team in a ... This position works collaboratively across many departments at Commonwealth Care Alliance ( CCA ) as well as externally to facilitate timely resolution of all… more
    Commonwealth Care Alliance (05/21/25)
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  • CIC Registered Nurse

    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 (07/03/25)
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  • Utilization Management Reviewer

    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 (07/31/25)
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  • Clinical Informaticist

    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 (06/25/25)
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  • Palliative LICSW

    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 (06/25/25)
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  • Appeals and Grievances Program Advisor

    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 (06/06/25)
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  • Manager, Utilization Management

    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 ... care services, procedures, and facilities under the provisions of CCA 's benefits plan. The Manager, Utilization Management is responsible...services. This position has a key role in ensuring CCA meets CMS compliance standards in the area of… more
    Commonwealth Care Alliance (05/21/25)
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