The Health Plan Network Adequacy Analyst III reviews and analyzes the effectiveness and efficiency of existing market operation processes and systems, ensures compliance of State and Federal Network Adequacy Standards, and participates in development of solutions to improve or further leverage these functions. Essential Functions Manage new and ongoing market network adeq

The Housing Supports and Services Specialist III NV plays a vital role in administering the Housing Supports and Services Program, specifically providing In Lieu of Services (ILOS) for Nevada Medicaid. This position is responsible for coordinating comprehensive strategies for eligible members, ensuring they receive the necessary support to secure and maintain stable housi

ElderServe Health is a mission driven, nonprofit managed care organization serving the New York metropolitan area. ElderServe provides long term services and supports to more than 20,000 older adults and adults with disabilities across New York City, as well as Westchester, Nassau, and Suffolk Counties. ElderServe primarily serves a frail and elderly membership who is pre

The Medical Director is responsible for supporting staff by providing training, clinical consultation, and clinical case review for members. Essential Functions Provide prior authorization medical reviews, consultation and clinical review services Participate in peer to peer discussions Provide provider education, training, data sharing, performance evaluations and orient

Commonwealth Care Alliance (CCA) is a nonprofit, mission driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massac

The Information Security Engineer III is responsible for designing and developing technologies and processes to monitor operation of IT systems to detect suspicious activity that could indicate an attempted or actual intrusion into the enterprise network. Essential Functions Apply creative thinking in problem solving and identifying opportunities for improvements in secur

The Information Security GRC Analyst III managed day to day, short and long term information security risks and ensures activities are within risk tolerance and in compliance with approved risk management policies, procedures and limits. Essential Functions Measure, monitor, and report on information security risks Review and report on vendor/third party risk to support v

The Special Investigations Unit (SIU) Investigator II is responsible for investigating and resolving moderate complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Essential Functions Conduct investigations on own initiative or at the request of management; investigation includes data analysis, record review, c

ElderServe Health is a mission driven, nonprofit managed care organization serving the New York metropolitan area. ElderServe provides long term services and supports to more than 20,000 older adults and adults with disabilities across New York City, as well as Westchester, Nassau, and Suffolk Counties. ElderServe primarily serves a frail and elderly membership who is pre

Commonwealth Care Alliance (CCA) is a nonprofit, mission driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massac

The Compliance Analyst II position is a professional compliance role responsible for supporting the Compliance Program by collaborating and overseeing high risk areas to ensure that the compliance program is effective and efficient in identifying, preventing, detecting, and correcting noncompliance. Essential Functions Compliance Prevention Provide analysis, interpretatio

Commonwealth Care Alliance (CCA) is a nonprofit, mission driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massac

The Revenue Cycle Coordinator III is responsible for providing oversight in the research and resolution of member related eligibility and billing complaints from internal customers and governing entities. Essential Functions Utilize key accounts receivable and reporting experience and knowledge to ensure timely and accurate recording and reporting of accounts receivable a

The Operations Specialist III provides analytical support and leadership for key Claims related projects. Essential Functions Regulatory reporting such as CMS and Medicaid Prompt Pay Serve as high dollar claims reviewer Identify payment integrity issues with claims reimbursement methodologies Prepare and deliver responses to legal correspondence and state complaints Provi

Commonwealth Care Alliance (CCA) is a nonprofit, mission driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massac