Job Summary: The Market Medical Director is responsible for the implementation of market-level clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards. Essential Functions: Support staff by providing training, clinical consultation, 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 Senior Manager, DSNP Bid Strategy & Development is responsible for DSNP bid strategy and execution, ensuring compliant, accurate, and competitive submissions across states and plan years. Translates CMS guidance and cross‑functional input into
Job Summary: The Senior Manager, DSNP Product Operations provides end‑to‑end operational leadership for DSNP products, ensuring regulatory compliance, scalability, and readiness across markets and plan years, translating DSNP strategy into executable operations through cross‑functional partnership, performance
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 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 Enterprise Medical Director is responsible for the development, implementation and revision of corporate level clinical care standards and practice guidelines, ensuring compliance with nationally accepted quality standards. Essential Functions: Development, implementation and revision
Job Summary: The Special Investigations Unit (SIU) Investigator Lead is the face of the SIU with external federal and state regulatory agencies and is responsible for regulatory communications to ensure timeliness with these oversight agencies. This
Job Summary: The Regulatory Affairs Director is responsible for leading activities of the Regulatory Affairs Department, including contracts, compliance, surveys, audits, investigations, reporting, plan development and renewal, credentialing, Fraud, Waste & Abuse Special Investigations, provider network
Job Summary: The Market Quality Improvement Specialist II collaborates with department manager and other leadership to evaluate opportunity for HEDIS data and process improvement in new or existing projects with focus on measurable benefits. Essential Functions:
Job Summary: The Care Delivery Triage RN is responsible for performing telephonic clinical triage and providing health information service and care coordination as a key part of the primary care team, and acts as the primary
Job Summary: The Senior Director, Field Sales is responsible for driving statewide membership growth and achieving enrollment targets across Medicare, DSNP, and related product lines. This position leads the development and execution of local sales strategies
Job Summary: The Actuarial Analyst I is responsible for providing timely, accurate, and actionable data and analysis supporting the department, area, and corporate key initiatives. Essential Functions: Develops actionable recommendations to management relative to all analysis
Job Summary: The VP, Network Strategy & Contracting is responsible for creating and executing the Market Network strategic plan including leading the market with Value Based Purchasing initiatives that differentiate and enable the market to excel,
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 Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population with culturally
Job Summary: The Director, Pharmacy Clinical Strategy leads the strategic development of formulary management best practices & industry-leading, market-competitive formulary and medical drug strategies across all CareSource lines of business and markets. Essential Functions: Ensures the efficient
Job Summary: The Manager, Market Contracting is responsible for assisting the Director, and managing a team, to manage and negotiate assigned contracts including analysis of the contract proposals and conducting financial impact to make informed decisions
Job Summary: The Program Integrity Medical Coding Reviewer III supports most complex medical record audit programs, dispute management, escalation management and generates concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid