We are seeking experienced TriZetto Clinical CareAdvance (CCA) Configuration experts to support a large-scale Utilization Management (UM) and Prior Authorization (PA) modernization program for a leading US Healthcare payer. The role involves hands-on configuration of CCA workflows, business rules, authorizations, correspondence, and integrations.
Key Responsibilities
- Configure CCA workflows and business processes
- Configure ABRE (Advanced Business Rules Engine) for Prior Authorization and auto-authorization
- Configure Utilization Management (UM), Appeals & Grievances (A&G;), and clinical workflows
- Configure TCS correspondence and RightFax integrations
- Support FACETS integration, benefit mapping, pharmacy,
and provider-administered drug workflows
- Configure automated case creation, routing, and closure rules
- Prepare configuration documentation and support CCA platform modernization
Required Skills
- 5+ years of hands-on TriZetto Clinical CareAdvance (CCA) configuration experience
- Solid experience with ABRE, Prior Authorization (PA), and Utilization Management (UM)
- Experience with US Healthcare Payer, Medicare, and Medicaid
- Knowledge of TCS, RightFax, FACETS integration, and clinical workflow configuration is preferred