JOB SUMMARY: The Compliance and Risk Management Specialist assists in the ongoing success of CommunityCare... risk tolerance levels, and reports on the status of ongoing monitoring of key controls in support of CommunityCare...
operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing...
outreach, exceptional service, and personalized support. The Retention Specialist helps CommunityCare achieve membership growth... events to ensure members are fully informed about CommunityCare benefits and offerings. Contact at-risk members...
understanding and sensitivity to the unique needs of the CommunityCare population. This role spends 100% of time on quality program...
JOB SUMMARY: Responsible for the development, planning and implementation of CommunityCare’s strategic software...
in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans...
CommunityCare brand and mission to broker partners (broker agencies, agents and FMOs), contracted providers/health systems..., community leaders and organizations through CommunityCare in person events, health fairs, social and digital marketing...
that wish to be join one of the CommunityCare health plans. Our advocates also provide support via outbound and inbound phone...
in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans...
operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing...
and requests in accordance with CommunityCare's grievance and appeals procedures. Ensures appropriate file documentation...
and Responsibilities: Perform other special projects and duties as assigned by the executive staff of CommunityCare Managed Healthcare...
JOB SUMMARY: The Medical Director provides physician-level clinical review expertise within the health plan’s utilization management, appeals, and clinical governance programs. The Medical Director applies evidence-based clinical judgment...
JOB SUMMARY: The Vendor Management Administrator is responsible for centrally supporting vendor selection, due diligence, contract negotiation, and ongoing internal relationship management activities relative to vendors. This position pla...
JOB SUMMARY: Responsible for auditing and monitoring company processes. Meets with stakeholders to review corrective action and obtain resolution. Conducts follow-up audits to ensure corrective actions have addressed the root cause to pre...
JOB SUMMARY: Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints. KEY RESPONSIBILITIES...
JOB SUMMARY: Responsible for providing technical and customer service support for pharmacy benefits, processing prior authorizations according to CMS and State regulations, and resolving pharmacy related complaints. KEY RESPONSIBILITIES...
JOB SUMMARY: The Senior HR Business Partner addresses employee concerns, promoting engagement and ensuring a fair and consistent application of company policies. Serves as an advisor to managers and employees for employee relations, inves...
JOB SUMMARY: The Technical Product Owner (TPO) serves as the bridge between business needs and technical implementation, ensuring that product development aligns with strategic objectives and delivers measurable value. The TPO partners cl...
JOB SUMMARY: Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other mem...