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Shared Learning for Integrated Care Programs
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The password must have at least 6 characters
Password
Email address
Email (again)
First name
Last Name
City/town
State
Select a state
Alabama
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Professional Information (for PACE Trainings choose N/A for questions that do not relate to you or your work)
Professional Information (for PACE Trainings choose N/A for questions that do not relate to you or your work)
Professional Information (for PACE Trainings choose N/A for questions that do not relate to you or your work)
Who is your employer?
NPI (National Provider Identification #)
Tax Identification Number (if NPI is left blank)
Please write out your primary job title (where you spend the most time):
Is your Organization part of any of the following One Care plans? Choose N/A if you are not affiliated with One Care
Is your Organization part of any of the following One Care plans? Choose N/A if you are not affiliated with One Care
Is your Organization part of any of the following One Care plans? Choose N/A if you are not affiliated with One Care
Commonwealth Care Alliance
Yes
No
I Don't Know
N/A
Community Care Cooperative, Inc. (C3)
Yes
No
I Don't Know
N/A
Mass General Brigham Health Plan (MGBHP)
Yes
No
I Don't Know
N/A
Senior Whole Health by Molina Healthcare (Molina)
Yes
No
I Don't Know
N/A
Tufts Health Unify
Yes
No
I Don't Know
N/a
United
Yes
No
I Don't Know
N/A
List your professional affiliations: (check all that apply. If none apply, specify credential in “Other”)
List your professional affiliations: (check all that apply. If none apply, specify credential in “Other”)
List your professional affiliations: (check all that apply. If none apply, specify credential in “Other”)
Administrative - Management (CEO, Director, Manager, Supervisor)
Administrative - Operations (Member Services, Quality, Finance, Admin. Assistant)
Allied Health Professional (PT, OT, Speech, RT, Nutrition, Rehab Counselor)
Bachelor's degree (BA, BS)
Behavioral Health (Psychologist, LMHC, peer counselor, peer specialist)
Case Manager, Care Manager, Care Coordinator
CNA, Medical Assistant or HHA
Independent Living/Community Worker (LTS Coordinator, Skills Trainer, CHW )
JD
Master’s degree (MBA, MPH, MPP, MPA or MEd)
MD
NP
PA
Pharmacy (Pharmacist, CPhT)
RN or LPN
Social Work
Specialist (Podiatrist, Optometrist, Dentist, Chiropractor, other Specialist)
Other (please specify)
How would you describe your area of focus: (check as many as apply)
How would you describe your area of focus: (check as many as apply)
How would you describe your area of focus: (check as many as apply)
Primary Care (PCPs and primary care offices)
Care Coordination (at a One Care plan)
Other One Care plan staff (other than Care Coordination)
Behavioral Health (mental health providers or recovery organizations)
Long Term Services & Supports (ILCs, ASAPs or home and community-based service agencies)
MA State Agencies
Other State or Federal Medicaid Offices
Other
Security question
Required