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Anba la a se yon lis fonksyon ou ka fè rechèch lè w ap chèche yon pozisyon nan CCP.

Reklamasyon

Apre doktè & rsquo; ak lòt founisè & rsquo; sèvis yo konplete sou non enskri nou yo, Depatman Reklamasyon nou an ap trete demann yo pou peye.

Konfòmite

Depatman CCP Konfòmite responsab pou asire ke CCP, Konsèy Administrasyon CCP, jesyon ak anplwaye yo an konfòmite ak tout lwa gouvènman, règleman ak règleman yo. Anba ejid Depatman Konfòmite a, Inite Envestigasyon Espesyal CCP nou an responsab pou detekte, envestigasyon, ak rapòte sikonstans fwod, fatra, ak abi ke Medicaid anwole, founisè ak enstalasyon komèt.

Finans

Ekip finansye nou an responsab pou planifye, òganize, odit, ak kontablite pou finans nou yo kòm byen ke pwodwi deklarasyon finansye nou yo.

Pwogram Gouvènman

Ekip Pwogram Gouvènman nou an ap travay dirèkteman avèk ajans leta kontraktye nou yo pou asire konpayi nou an satisfè tout kondisyon kontra yo pou yo ka bay pi bon kalite swen pou anwole yo.

Resous imen

Anplwaye nou yo se kè Community Care Plan. Depatman Resous Imèn fè efò pou satisfè bezwen yo epi adrese enkyetid yo nan anplwaye nou yo epi bay yo fòmasyon, zouti ak edikasyon pou fè travay yo ak pasyon, angajman ak devouman, osi byen ke rive nan objektif pwofesyonèl yo.

Teknoloji enfòmasyon

Depatman IT nou an sipòte objektif òganizasyonèl CCP yo pa devlope, mete ann aplikasyon ak kenbe òdinatè konpitè ak sistèm lojisyèl ki òganize ak kominike enfòmasyon elektwonikman. Responsablite yo varye de kenbe sistèm ak done ki an sekirite nan kenbe rezo leve, li kouri.

Jesyon medikal

  • Credentialing Pou asire enrolles nou resevwa sèvis bon jan kalite swen sante, ekip kredansyèl nou an verifye kalifikasyon, background ak edikasyon founisè ki mande manm nan rezo doktè nou yo.
  • Famasi Depatman an famasi CCP sipèvize ak administre benefis medikaman doktè preskri ak sèvis terapi medikaman pou enskri Medicaid yo ak tout liy komèsyal biznis yo. Anplwaye Famasi nou yo sipèvize bon jan kalite, itilizasyon, ak jesyon pri nan pharmaceutique nan antretyen fòmil ak sipèvizyon, pwosesis reklamasyon egzat, sipèvizyon otorizasyon anvan yo, famasi depanse, ak itilizasyon jenerik, ak objektif bon kalite, pharmaceuticals pri-efikas pou tout anwole.
  • Sante Popilasyon Depatman Sante Popilasyon nou an gen ladan anplwaye klinik (RN, rsquo; s ak travayè sosyal), ak anplwaye sipò administratif ki travay avèk enskripsyon pou ede yo jere kondisyon medikal yo epi ankouraje yo pou yo pratike swen tèt yo.
  • Kalite ak klinik amelyorasyon pèfòmans Jesyon kalite ekip RN nou an konsantre sou mezi pèfòmans plan sante, epitou revize potansyèl kalite pwoblèm swen ak evènman negatif, edikasyon founisè konsènan Child Health Check Up ak mezi HEDIS, syans sante, ak akreditasyon.
  • Jesyon Itilizasyon Lè enskri nou yo bezwen tretman, pwosedi, tès, ak swen medikal avanse, depatman jesyon itilizasyon CCP, yon anplwaye nan pwofesyonèl medikal ak anplwaye sipò, demann revizyon ki mande anvan otorizasyon plan sante a.

Sèvis Manm

Nan kè a nan pwogram sèvis kliyan nou yo, anplwaye nan Sèvis Manm pran apèl ak okipe demann ki soti nan enskri nou yo. Anplwaye a gen ladan reprezantan Sèvis Manm ak asosye, tout konsantre sou bay eksepsyonèl sèvis gardyen.

Founisè Founisè yo

Ekip Operasyon Founisè nou konprann enpòtans pou devlope ak kenbe relasyon solid avèk founisè rezo nou yo. Yo travay avèk founisè nou yo pou elimine defi yo epi pou bay bon kalite swen sante pou enskri nou yo. Founisè Operasyon Kontra yo epi kenbe rezo founisè nou an annakò avèk bon jan kalite ak direktiv kontra.

Apply Now

Below is a list of functions you can search when seeking a position at CCP.

Claims

After physicians’ and other providers’ services are completed on behalf of our enrollees, our Claims Department processes their requests for payment.

Compliance

The CCP Compliance department is responsible for ensuring that CCP, the CCP Board of Directors, management and employees are in compliance with all government statutes, rules and regulations. Under the auspices of the Compliance Department, our CCP Special Investigations Unit is responsible for detecting, investigating, and reporting instances of fraud, waste, and abuse committed by Medicaid enrollees, providers and facilities.

Finance

Our Finance team is responsible for planning, organizing, auditing, and accounting for our finances as well as producing our financial statements.

Government Programs

Our Government Programs team works directly with our contracted state agencies to ensure our company meets all contractual requirements in order to provide the highest quality of care to our enrollees.

Human Resources

Our employees are the heart of Community Care Plan. The Human Resources department strives to meet the needs and address the concerns of our staff and provide them with the training, tools and education to perform their jobs with passion, commitment and dedication, as well as reach their professional goals.

Information Technology

Our IT department supports CCP’s organizational goals by developing, implementing and maintaining computer hardware and software systems that organize and communicate information electronically. Their responsibilities range from keeping systems and data secure to keeping networks up and running.

Medical Management

  • Credentialing To assure our enrollees receive high quality health care services, our Credentialing team verifies the qualifications, background and education of providers who request membership in our physician network.
  • Pharmacy The CCP Pharmacy Department oversees and administers prescription drug benefits and Medication Therapy Management services for our Medicaid enrollees and all commercial lines of business. Our Pharmacy staff oversee quality, utilization, and cost management of pharmaceuticals through formulary maintenance and oversight, accurate claims processing, oversight of prior authorizations, pharmacy spend, and generic utilization, with the goal of quality, cost-effective pharmaceuticals for all enrollees.
  • Population Health Our Population Health department is comprised of clinical staff (RN’s, LPN’s and Social Workers) as well as administrative support staff who work with enrollees to help them manage their medical conditions and encourage them to practice preventive self-care.
  • Quality And Clinical Performance Improvement Our Quality Management RN team focuses on health plan performance measures, as well as review of potential quality of care issues and adverse events, provider education regarding Child Health Check Up and HEDIS measures, health studies, and accreditation.
  • Utilization Management When our enrollees need treatments, procedures, tests, and advanced medical care, CCP’s utilization management department, a staff of medical professionals and support staff, review requests that require prior authorization by the health plan.

Member Services

At the heart of our customer service program, the Member Services staff takes calls and handles requests from our enrollees. The staff consists of Member Services representatives and associates, all focused on providing outstanding concierge service.

Provider Operations

Our Provider Operations team understands the importance of developing and maintaining strong relationships with our network providers. They work with our providers to eliminate challenges and provide excellent quality healthcare for our enrollees. Provider Operations contracts and maintains our provider network in accordance with quality and contractual guidelines.