Why This Role is Important to Us The Provider Relations Specialist is responsible for cultivating, maintaining and strengthening relationships with the Commonwealth Care Alliance's (CCA) provider community. In this highly visible field position, the provider relations specialist acts as the primary liaison between CCA and its providers including primary care practices, sp

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann

Why This Role is Important to Us Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible for the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsi

Why This Role is Important to Us The Specialist, Quality Provider Engagement ACO/PO monitors Quality Measures within Accountable Care Organization physicians' offices for Group Practice Reporting Options (GPRO). Conducts onsite reviews and audits for Medicare compliance. This position partners with providers to support in office improvement efforts aimed at increasing the

Why This Role is Important to Us Commonwealth Care Alliance (CCA) is thrilled once again to host its Summer Internship Program for clinical and non clinical departments!The Internship Program is open to undergraduate and graduate students from across the country. CCA Internships are a valuable way for students to obtain real world experience, gain exposure to a specific f

Why This Role is Important to Us Commonwealth Care Alliance (CCA) is thrilled once again to host its Summer Internship Program for clinical and non clinical departments!The Internship Program is open to undergraduate and graduate students from across the country. CCA Internships are a valuable way for students to obtain real world experience, gain exposure to a specific f

Why This Role is Important to Us The Provider Contract Manager is responsible for developing, negotiating and managing contractual, legal and financial arrangements with providers that ensure CCA members have superior access to the highest quality, cost effective providers of healthcare services. What You'll Be Doing Develop, negotiate and maintain provider contracts for

Why This Role is Important to Us The Nurse Utilization Management (UM) Reviewer is responsible for day to day timely clinical and service authorization review for medical necessity and decision making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and organizational determinations.

Respond and effectively triage member phone calls in order to accurately and timely route to appropriate area Work with care management team to address the needs of members, caregivers and other CCA constituents Provide timely and accurate information regarding member benefits and services including Continuity of Care Meticulously document all member and prospective membe

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann

Be a resource for CCAs members by providing accurate and timely responses to their benefit and health plan questions. Respond and effectively triage member phone calls to accurately route to appropriate area. Work with care management team to address the needs of members, caregivers and other CCA constituents. Conduct all follow up activities in a timely and accurate mann