operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing...
JOB SUMMARY: Responsible for the development, planning and implementation of CommunityCare’s strategic software...
understanding and sensitivity to the unique needs of the CommunityCare population. This role spends 100% of time on quality program...
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...
and requests in accordance with CommunityCare's grievance and appeals procedures. Ensures appropriate file documentation...
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...
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...
JOB SUMMARY: Responsible for working with members, providers, and other multidisciplinary team members to facilitate, collaborate and coordinate healthcare for members identified with complex healthcare needs. Work with members throughout...
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 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: 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 selling Medicare products and Individual Health Plan products via telemarketing calls and person-to-person meetings, including seminars. KEY RESPONSIBILITIES: Discuss products and benefits with eligible be...
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: 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: Responsible for maintaining and supporting the Help Desk and new systems, which includes network installations, personal computers support and maintenance, and infrastructure development. Provides support for Telecommunicatio...
JOB SUMMARY: In compliance with federal, state, and accreditation requirement, this position is responsible for overseeing activities and personnel involved in the day to day operations of grievance and appeals for all lines of business. ...
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...