JOB SUMMARY: The Cost Containment Specialist is responsible for ensuring CommunityCare receives appropriate... in claims processing, data entry or medical billing. One year of claims processing experience within CommunityCare...
operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing...
in accordance with federal and state mandates, and credentialing criteria as outlined in the CommunityCare Managed Healthcare Plans...
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...
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 providing daily guidance, instruction, and training to inspire the team to perform at their optimum. In addition, they will provide support to Customer Service Representatives by being a subject matter expert....
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 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 Retrieval Specialist is responsible for requesting, collecting, organizing, and processing medical records to support Risk Adjustment, HEDIS, and Quality Improvement initiatives. This role manages all outbo...
JOB SUMMARY: The Software Engineer II will build out the next generation of our platform. As a Software Engineer II, you are expected to work independently, and within teams, leading the development of software features. You will be invol...
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...