• Medicare/ Medicaid Claims Reimbursement…

    Commonwealth Care Alliance (Boston, MA)
    …The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and ... direct support to leadership in pricing determinations and dispute case documentation. **Working Conditions:** + Standard office conditions. **Required Education… more
    Commonwealth Care Alliance (05/31/25)
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  • Payment Integrity Subrogation Manager - REMOTE

    Molina Healthcare (Everett, WA)
    …responsible for overseeing all aspects of healthcare subrogation operations across Medicaid , Medicare, and Marketplace lines of business. This includes direct ... role requires experience across a wide range of subrogation case types-including automobile-related claims (eg, no-fault/PIP), workers' compensation, general… more
    Molina Healthcare (07/23/25)
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  • Staff Attorney - Staff Attorney 2

    State of Minnesota (St. Paul, MN)
    …: Human Services Dept / MAPE DHS Central Office + **Division/Unit** : Health Care Administration / Integrity and Accountability + **Work Shift/Work Hours** : Day ... for the Department's compliance objectives and daily activity within the DHS Health Care Integrity & Accountability (HCIA) Division. This position serves as a… more
    State of Minnesota (07/23/25)
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  • Manager, Utilization Management

    Commonwealth Care Alliance (Boston, MA)
    …of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits ... Part B medications, long term services and supports (LTSS), and home health (HH). * Maintains and optimizes Standard Operating Procedures related to authorization… more
    Commonwealth Care Alliance (05/21/25)
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  • Utilization Review Medical Director

    Commonwealth Care Alliance (Boston, MA)
    …(a) Full-time experience as an administrator in a Medicare or state-level Medicaid program, Health Maintenance Organization (HMO); and (b) Preferred Provider ... specific clinical issues with attending physicians and CCA clinicians + Document case review findings, actions, and outcomes in accordance with Utilization +… more
    Commonwealth Care Alliance (06/27/25)
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  • CIC Advanced Practice Clinician

    Commonwealth Care Alliance (Springfield, MA)
    …medical care delivery and care coordination for the most complex medical and behavioral health patients. The APC functions within and is integral in a highly skilled ... reduction * Goals of Care conversations, including completion of Health Care Proxy and MOLST forms * Long Term...and CCA Leaders. * Identify and lead ad hoc case reviews with internal/external care team as needed. *… more
    Commonwealth Care Alliance (07/09/25)
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  • Nurse Utilization Management Reviewer

    Commonwealth Care Alliance (Boston, MA)
    …Part B medications, Long Term Services and Supports (LTSS),DME and Home Health (HH) + Applies established criteria (eg, InterQual and other available guidelines) ... RN **Desired Licensing (nice to have):** + CCM (Certified Case Manager) **Required Experience (must have):** + 2 to...to have):** + 2 or more years of Home Health Care experience + 2 or more years of… more
    Commonwealth Care Alliance (05/23/25)
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