- 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 the ... Management Manager. * Conducts timely 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)
- …& 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
- ARAMARK (Barbourville, KY)
- …and follow safety guidelines, but you?ll master customer service and social skills! Prior experience isn?t the most important thing ? we're looking for students who ... are ready to be trailblazers with Aramark. Pursue what matters and apply to join our team today. Essential functions and responsibilities of the position may vary by location based on client requirements and business needs. **Job Responsibilities** Prepares… 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)
- …+ Evaluate the effectiveness of the company's medical policies and prior authorization program in collaboration with other leads, including via reporting ... 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
- University of Virginia (Charlottesville, VA)
- …program is highly desired + Eligible for unrestricted medical licensure in the Commonwealth of Virginia prior to the start of appointment The University ... references. The University will perform background checks on all new hires prior to employment. A completed pre-employment health screen is required for this… more