Job Summary: Provides operational support and day-to-day coordination of rehabilitation services to ensure effective, compliant, and high-quality care delivery. Executes established program standards, supports utilization and clinical processes, and partners with internal teams and external providers
Job Summary: The Senior Director, Clinical Data Governance & Integration is responsible for developing, executing and coordinating enterprise clinical data governance and integration activities. This role ensures standardized business requirements, oversees governance cadence, and drives cross-functional
Job Summary: The Managing Actuary provides leadership and direction to ensure team goals and strategies are successfully achieved. Essential Functions: Responsible for pricing, forecasting, reserving or other actuarial processes including development of key assumptions, as well
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the members health needs while promoting quality cost effective outcomes.
Job Summary: The Nurse Care Manager is responsible for providing care coordination including in-home assessment, planning, facilitation, advocacy and authorization of covered plan services to meet the members health needs while promoting quality cost effective outcomes.
Job Summary: The Clinical Care Manager-Massachusetts at CareSource/Commonwealth Care Alliance (CCA) is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs.
Job Summary: The Care Delivery Advanced Practice Clinician (APC) provides comprehensive primary care and clinical care coordination to a panel of patients, including individuals with significant medical, behavioral, and social complexities that require intensive care coordination
Job Summary: The Behavioral Health Medical Director is responsible for the overall safety of patients with a BH diagnosis, with a special focus on safe prescribing. Essential Functions: Assume responsibility for the overall safety of patients
Job Summary: The Clinical Psychologist provides Behavioral Health coverage determination for utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting. Essential Functions: Assume responsibility for the overall safety of
Job Summary: The Customer Care Specialist I assists members/beneficiaries or providers with routine service inquiries. Essential Functions: Resolve member/beneficiaries or provider routine service inquiries; examples include claims processing, member benefit education, contracting and credentialing requests, and
Job Summary: The Integrated Care Clinical Manager - Massachusetts at CareSource/Commonwealth Care Alliance (CCA) is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and
Job Summary: The Integrated Care Clinical Manager - Massachusetts at CareSource/Commonwealth Care Alliance (CCA) is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
Job Summary: The Clinical Care Manager-Massachusetts is a community based registered nurse responsible for providing monitoring, follow-up and clinical care management to dually-eligible enrollees with complex medical, behavioral and social care needs. This position focuses on
Job Summary: The Operations Regulatory Specialist II provides analytical support and leadership for key internal Operations projects and partners with the Operations departments to ensure all regulatory and compliance deliverables are met. This position will work
Job Summary: The LTSS and Dual Eligible Program Manager is responsible for managing large-scale portfolio programs aligned to strategic objectives that include multiple projects. Essential Functions: Responsible for successful delivery of LTSS and Dual Eligible programs
Job Summary: The Human Resources Business Partner III serves as a strategic partner to senior leaders, aligning HR strategies and initiatives with business objectives and organizational culture. Essential Functions: Serve as a trusted advisor to senior
Job Summary: The Integrated Care Clinical Manager - BH - Massachusetts at CareSource/Commonwealth Care Alliance (CCA) is a community based BH Clinician responsible for providing monitoring, follow-up and clinical care management to dually eligible enrollees with complex
Job Summary: The Data Scientist II is responsible for designing and validating predictive models, machine learning models, and artificial intelligence that inform and improve business processes across the organization (operational, clinical, financial, marketing, etc.). Essential Functions:
Job Summary: The Board-Certified Behavior Analyst serves as the clinical lead in developing and implementing evidenced based clinical policies and practices for members with Autism and their families Essential Functions: Oversee coverage determinations for ABA utilization