- CVS Health (Austin, TX)
- …This person will facilitate collaborative partnerships with different departments to meet NCQA standards while monitoring for state requirements as they align with ... different areas to fulfill these requirements. * Accountable for NCQA and state projects and initiatives through direction setting...implements project plans to ensure resolution and compliance to NCQA standards * Schedules and conducts NCQA … more
- McLaren Health Care (Indianapolis, IN)
- …https://www.mdwise.org/ **Position Overview:** Responsible for acquiring, maintaining, and maximizing NCQA Health Plan and Health Equity Accreditation and other ... across standards. Serves as a liaison between the Plans and NCQA guiding the Plans on NCQA policies and procedures, negotiates the survey process as well as… more
- Humana (Columbus, OH)
- …coaching, and general support. + Serves as subject matter expert on NCQA Health Plan Accreditation requirements and advising team and other operational areas ... closely with operational areas to prepare documentation for submission to NCQA . + Advises operational leaders and frontline associates in developing functional… more
- Hackensack Meridian Health (Neptune, NJ)
- …activities to ensure compliance with National Committee for Quality Assurance ( NCQA ), contractual agreements, and State and Federal requirements. This is a ... files accurately. + Demonstrate a solid understanding of credentialing and NCQA guidelines around Credentialing and Provider Network. + Verifying the accuracy… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …of Extract, Transform, and Load (ETL) data processes. . Basic knowledge of HEDIS, NCQA and CMS Stars. . Basic to intermediate skills in database reporting and ... and Load (ETL) data processes. . Knowledge of HEDIS, NCQA and CMS Stars quality metrics. . Knowledge of...and Load (ETL) data processes. . Knowledge of HEDIS, NCQA and CMS Stars quality metrics. . Knowledge of… more
- Molina Healthcare (Columbus, OH)
- …adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA -compliant ... and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. + Reviews quality referred issues, focused… more
- Centene Corporation (Carson City, NV)
- …Conduct training and education programs for Plan, provider network, delegated vendors to support NCQA and HEDIS activities. + Develop QI, NCQA and HEDIS projects ... vendors to support accreditation maintenance and HEDIS reporting. + Coordinate assigned NCQA and HEDIS work plan activities. + Assist with delegation oversight… more
- Centene Corporation (Jefferson City, MO)
- …in accordance with policies, guidelines, and National Committee for Quality Assurance ( NCQA ) standards. + Prepares case reviews for Medical Directors by researching ... processing, and response to appeal in accordance with State, Federal and NCQA standards + Communicates with members, providers, facilities, and other departments… more
- Molina Healthcare (Spokane, WA)
- …adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA -compliant ... and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. + Reviews quality referred issues, focused… more
- Centene Corporation (Sacramento, CA)
- …in accordance with policies, guidelines, and National Committee for Quality Assurance ( NCQA ) standards. + Prepares case reviews for Medical Directors by researching ... processing, and response to appeal in accordance with State, Federal and NCQA standards + Communicates with members, providers, facilities, and other departments… more
- Magellan Health Services (San Diego, CA)
- …in the member's care. Ensures that contract requirements, accreditation standards (eg NCQA ), state policies and federal policies are implemented specific to each ... adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA -compliant… more
- Genesis Healthcare (Seven Fields, PA)
- …by therapists. 2. Reviews completed applications to ensure compliance with NCQA and other regulatory and license requirements; assists therapists with application ... ie renewal requirements. 4. Maintains provider database consistent with NCQA standards. 5. Handles correspondence with payer including updates, mailings… more
- Corewell Health (Grand Rapids, MI)
- …requirements including Medicare, Medicaid, National Committee on Quality Assurance ( NCQA ), and other applicable federal and state regulations, statutes and ... with regulatory and accreditation requirements and to ensure Medicare, Medicaid and NCQA audit readiness for the Medical Management department. This includes but is… more
- Elevance Health (Grand Prairie, TX)
- …wide which are necessary for submission of audited HEDIS and CAHPS results to NCQA , CMS, and State Regulatory Agencies. Primary duties may include, but are not ... audit. + Conducts the ongoing evaluation and interpretation of NCQA , CMA, and State HEDIS requirements to ensure compliance...and Medicaid State Auditors. + Strong knowledge of the NCQA HEDIS audit guidelines and processes used to submit… more
- Sharp HealthCare (San Diego, CA)
- …collaboration necessary for the continuum of care foundation for our NCQA required population health management program. Additionally, this position provides the ... clinical teams. + Assists CMO in the implementation of NCQA top decile improvement programs and work plans. +...committees, and the SHP Chief Medical Officer. + Supports NCQA survey activities. Prepares for site visits and responds… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance ( NCQA ), and the DNV standards throughout the enrollment and credentialing process. + ... + Administers credentialing and enrollment processes in accordance with NCQA guidelines, including quality assurance and compliance tasks, delegated credentialing… more
- LA Care Health Plan (Los Angeles, CA)
- …Department of Managed Health Care (DMHC), National Committee for Quality Assurance ( NCQA ) etc. This position supervises all aspects of running an efficient teams, ... Experience with regulatory compliance such as CMS, DMHC, DHCS, and NCQA . Active experience in the Plan-Do-Study-Act process. Experience in compliance, accreditation,… more
- Somatus (Mclean, VA)
- …Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements, and company credentialing policies. + Ensure ... + Maintain working knowledge of the National Committee on Quality Assurance ( NCQA ) standards and State and Federal regulations related to credentialing. + Other… more
- CareOregon (Portland, OR)
- …assessment efforts. + Lead organizational readiness and improvement initiatives for NCQA Quality Accreditation by aligning Network Access and Adequacy Program ... functions and standards with NCQA requirements and developing comprehensive work plans to enhance...Six Sigma, or similar process improvement methodologies + Applied NCQA experience and knowledge Knowledge, Skills and Abilities Required… more
- LA Care Health Plan (Los Angeles, CA)
- …to ensure completeness, compliance with National Committee for Quality Assurance ( NCQA ), California Department of Health Care Services (DHCS) and other regulatory ... satisfaction. Duties Reviews medical records to ensure completeness, compliance with NCQA , DHCS and other regulatory requirements. Ensure records are complete and… more