in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans...
and structure of CommunityCare’s utilization and care management programs. Serves as principal clinical advisor for medical...
and distributing materials. Communication and interpersonal skills need to represent CommunityCare’s brand and image. Performs...
JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibi...
JOB SUMMARY: The Medical Records Clerk Intern’s primary responsibility will be to submit records requests and retrieve medical records for risk adjustment and as needed for HEDIS projects. The records clerk monitors and documents record r...
JOB SUMMARY: Supervise and lead the Cost Containment team (which includes COB, TPL, Reinsurance, Refunds and Recoupments) and the Recalculations team, including management of performance, work schedules and related metrics. Resolve comple...
JOB SUMMARY: This position is a part of a team that provides support to Brokers via email and phone communication. Support is provided for billing/invoice inquiries, eligibility inquiries, claims inquiries, and benefit verification. As a ...
JOB SUMMARY: The Medical Records Clerk Intern’s primary responsibility will be to submit records requests and retrieve medical records for risk adjustment and as needed for HEDIS projects. The records clerk monitors and documents record r...
JOB SUMMARY: This position is a part of a team that provides support to Brokers via email and phone communication. Support is provided for billing/invoice inquiries, eligibility inquiries, claims inquiries, and benefit verification. As a ...
JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibi...
JOB SUMMARY: Supports the Company in the development and execution of business strategies through detailed research, data analysis, and strategic recommendations. This individual will work closely with cross-functional teams to assess mar...
The Compensation Analyst is responsible for supporting the development, implementation, and maintenance of the company's compensation programs. This role involves conducting market analysis, administering salary structures, preparing compen...
JOB SUMMARY: The Provider Performance Specialist plays a key role in strengthening relationships between the health plan and its provider network by offering education, support, and guidance on performance improvement initiatives. This po...
JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibi...
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...
JOB SUMMARY: The Quality Improvement Stars Specialist is an integral part of the team, focusing on enhancing the performance of quality programs. This role requires a proactive individual who is adept at working collaboratively with provi...
JOB SUMMARY: The Senior Data Engineer is responsible for expanding and optimizing our data and data pipeline architecture, as well as optimizing data flow and collection across organizational teams. The Sr. Data Engineer will support our ...
JOB SUMMARY: Responsible for being the first point of contact for all membership related questions, requests and concerns and for providing outstanding service to our customers. You will answer queries regarding customer benefits, eligibi...
JOB SUMMARY: Responsible for supervising and coordinating daily workflow and leadership of staff. Activities include developing operating procedures and managing personnel and resources. KEY RESPONSIBILITIES: Serves as a resource to t...
JOB SUMMARY: Responsible for the development and implementation of new computer applications in addition to maintaining and executing applications. KEY RESPONSIBILITIES: Design, code and implement applications related to operations an...