- Sharp HealthCare (San Diego, CA)
- …What You Will Do Manage an effective in-patient Care Management program that includes initial and concurrent review; case management/discharge planning activities. ... plans related to health plan audits and requirements of NCQA . Collaborates with the Quality, Compliance and Training Department...and implements new programs under the direction of the manager of in-patient care management and the Director of… more
- Blue KC (MO)
- …discount program ** **Job Description Summary:** The Integrated Health Advancement Program Manager leads an integrated behavioral health and health outcome ... performance measurement, including design of incentive programs, HEDIS/STAR improvement efforts, and NCQA accreditation or Health Equity Accreditation +… more
- The Cigna Group (Bloomfield, CT)
- … Support** + Define and consult on measurement strategies and tools to support NCQA accreditation and state regulatory requirements + Ensure data integrity and ... **Job Profile Summary:** The Business Analytics Sr. Manager oversees a team of analytics professionals focused on clinical quality measurement and insights. Works in… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Federal Employee Program (FEP) and National Committee for Quality Assurance ( NCQA ) accreditation standards, as appropriate to the member's case assignment. ... Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the… more
- CDPHP (Latham, NY)
- …Federal Employee Program (FEP) and National Committee for Quality Assurance ( NCQA ) accreditation standards, as appropriate to the member's case assignment. ... Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …CMS, NCQA and BlueCross BlueShield Association (BCBSA) for the Federal Employee Program (FEP). The Manager serves as a resource to management, internal ... and all regulatory and accrediting standards including NYS DOH, CMS, FEP and NCQA formal accreditation activities. Keeps abreast of changes and responsible for… more
- MVP Health Care (Schenectady, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Case Manager , Medicaid Long Term Support Program ** to join #TeamMVP. If you ... care. + Compliance & Quality: Ensure adherence to Medicaid, Medicare, and accreditation standards (eg, NCQA ), including documentation and reporting. + Cost… more
- Elevance Health (Los Angeles, CA)
- …employment, unless an accommodation is granted as required by law_ The **Clinical Quality Program Manager ** is responsible for serving as a liaison with and ... Maintains effective documentation of research programs to meet regulatory and Accreditation Standards. + Provides oversight to assure accurate and complete… more
- The Cigna Group (Bloomfield, CT)
- …acquisition strategy and data product support within the Enterprise Quality & Accreditation organization. The data being acquired will be used to measure clinical ... will feed into HEDIS (healthcare effectiveness data and information set) and NCQA (national committee for quality assurance) accreditations. This position will be… more
- Fallon Health (New Bedford, MA)
- …provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for the Elderly)- in the region. ... and LinkedIn. **Brief summary of purpose:** The Nurse Case Manager (NCM) is an integral part on an interdisciplinary...for MassHealth programs such as the personal care attendant program , adult foster care, group adult foster care, and… more
- WellSense (NH)
- …manner and in keeping with contractual requirements, internal policy and NCQA accreditation standards. Facilitates multidisciplinary consultation on members' ... our members, no matter their circumstances. **Job Summary** The Clinical Care Manager provides holistic medical care management services for members throughout the… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you, we encourage you to apply! Job Description: This pharmacist clinician is a program manager , who is responsible for all Medicare Part D formulary creation ... while ensuring the longevity of the Plan's Part D program . Essential Accountabilities: + Develops and maintains the Part...and state regulatory agencies (CMS, DOH, DFS, etc.) and/or accreditation agencies ( NCQA , BCBSA) is preferred, but… more
- Chapa-De (Auburn, CA)
- …empowers teams and improves care at every level. The Quality Improvement Manager provides oversight and leadership on agency-wide quality and performance improvement ... Responsibilities: + Implements the Quality and Performance Improvement (QAPI) Program in alignment with the organization's mission, strategic goals, federal/state… more
- Sharp HealthCare (San Diego, CA)
- …**What You Will Do** Manage an effective in-patient Care Management program that includes initial and concurrent review; case management/discharge planning ... plans related to health plan audits and requirements of NCQA . Collaborates with the Quality, Compliance and Training Department...and implements new programs under the direction of the manager of in-patient care management and the Director of… more
- Molina Healthcare (Fort Worth, TX)
- …* Participates in preparation for national committee for quality assurance ( NCQA ) and utilization review accreditation commission (URAC) certifications. * ... services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …as required by state and federal regulations, National Committee for Quality Assurance ( NCQA ) accreditation standards, and CPRC policies. + Collaborate with the ... CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager / Compliance Consultant, Risk Specialist, Exception Review Specialists and Project… more
- Fallon Health (Plymouth, MA)
- …provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for the Elderly)- in the region. ... delivery of items as part of the 'Oh Baby' program and work with Nurse Case Managers to coordinate...needs + The Navigator refers to the Nurse Case Manager /PCP whenever clinical decision making is required. **Responsibilities** **Note:… more
- Integra Partners (Troy, MI)
- … Manager . + Ensure compliance with all regulatory, contractual, and accreditation standards (CMS, NCQA , state-specific requirements). + Support audit ... leadership duties, serving as both a mentor and performance manager for frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES… more
- Whitney Young Health Center (Albany, NY)
- …with local, State, and Federal regulation, ie DHHSHRSA and NYSDOH, and all accreditation standards (eg Joint Commission and NCQA -PCMH). + Adhere to the ... guidelines, policies and procedures. The Staff Pharmacist will also support the Pharmacy Manager in leading and directing the pharmacy team, by being accountable and… more
- Molina Healthcare (Rockford, IL)
- …key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. ... + Acts as a lead specialist to provide project-, program -, and / or initiative-related direction and guidance for...results to identify opportunities for improvement. + Surfaces to Manager and Director any gaps in processes that may… more
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