- Commonwealth Care Alliance (Boston, MA)
- … Nurse and Specialist staff responsible for conducting centralized clinical review and authorization creation for centrally authorized services. This position ... has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and...reports to the Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in… more
- Commonwealth Care Alliance (Boston, MA)
- …Manager will also oversee corporate and business-as-usual (BAU) communications, support regulatory compliance , and champion digital innovation in provider ... educational resources, and training materials, ensuring consistency of messaging and compliance with regulatory guidelines + Monitor and analyze provider… more
- Commonwealth Care Alliance (Boston, MA)
- …understanding of Medicare, Medicaid, duals program, and health plan operations, including regulatory and compliance requirements. - Demonstrated knowledge of DMH ... the performance of CCA's delegated partnerships programs, working with clinical community partners responsible for care management and utilization management… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Participate in Total Quality Management activities and processes to assure operational compliance with regulatory requirements, including NCQA, NEMIS, HCFA, and ... Case Managers. This position is responsible for the execution and implementation of Clinical Programs' strategy and goals and the oversight of Clinical Programs'… more
- Commonwealth Care Alliance (Boston, MA)
- …serves as a key liaison, proactively addressing provider needs, ensuring regulatory compliance , and supporting operational excellence to enhance provider ... educating on CCA's policies, program benefits, billing, referral and authorizations regulatory compliance , and contractual expectations. Conduct orientation and… more
- Commonwealth Care Alliance (Boston, MA)
- …of Medicare, Medicaid (MassHealth), and dual-eligible program operations, including regulatory and compliance requirements. - Demonstrated ability to ... closely with CCA's Behavioral Health, Health Home, Network, and Clinical teams to ensure a seamless provider experience and...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
- Commonwealth Care Alliance (Boston, MA)
- …improvement plans in partnership with internal and external stakeholders. + Ensure compliance with all regulatory and contractual requirements related to LTSS ... of **Medicare, Medicaid (MassHealth), and dual-eligible program operations** , including regulatory and compliance requirements. + Demonstrated ability to… more
- Jobleads-US (Juneau, AK)
- …candidate will use data science and operations research methodologies to recommend clinical staffing needs by skill type, pay type, and time type-ensuring efficient, ... Lead will be responsible for: Collaborate with HR, operations, clinical , and data teams to understand staffing requirements and...model and optimize staffing needs by skill type (eg, RN , PT, HHA), pay type (eg, hourly, salaried), and… more
- Seattle Children's (Seattle, WA)
- …staff development to meet current and anticipated needs and to maintain compliance with patient safety and regulatory requirements. **Relocation assistance ... Children's Hospital. The perinatal director is responsible for the day-to-day clinical nursing functions of the Special Perinatal Unit and Services. Accountable… more
- Commonwealth Care Alliance (Boston, MA)
- …Ensures compliance with all contract requirements, state and federal regulatory requirements and all applicable accreditation standards in improvement to promote ... the development of a high quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are integrated with care… more
