• Director, Accreditation, MI or IN Residency…

    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
    McLaren Health Care (01/12/25)
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  • Practice Facilitator - Quality

    Hackensack Meridian Health (Hackensack, NJ)
    …of practice improvement methodologies to ensure compliance with regulatory and NCQA standards. Dispute Resolution For day-to-day operations, the Patient Centered ... + PCMH Practice audit quarterly: assure practice is maintaining NCQA standards. + Work with team to acquire recognition...Work with team to acquire recognition of excellence in NCQA Diabetes and Heart Stroke + Submit quarterly and… more
    Hackensack Meridian Health (01/08/25)
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  • Delegated Credentialing Coordinator

    Hackensack Meridian Health (Neptune, NJ)
    …activities to ensure compliance with National Committee for Quality Assurance ( NCQA ), contractual agreements, and State and Federal requirements. The Delegated ... files accurately. + Demonstrate a solid understanding of credentialing and NCQA guidelines around Credentialing and Provider Network. + Verifying the accuracy… more
    Hackensack Meridian Health (12/28/24)
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  • Clinical Quality Data Analyst

    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
    Medical Mutual of Ohio (12/08/24)
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  • Medical Director

    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
    Molina Healthcare (01/13/25)
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  • RN Clinical Review Clinician - Appeals

    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
    Centene Corporation (01/12/25)
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  • Quality Improvement Coordinator II

    Centene Corporation (Phoenix, AZ)
    …initiatives at both the corporate and individual health plan levels according to NCQA , URAC and State requirements. + Work with Director of Accreditation to assist ... with Plan compliance to NCQA /URAC standards. + Maintain Quality Improvement policies and procedures in compliance with NCQA /URAC requirements and recommend… more
    Centene Corporation (01/10/25)
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  • Medical Director (Based in TX)

    Molina Healthcare (TX)
    …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
    Molina Healthcare (01/10/25)
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  • Manager, Quality Data Reporting and Analytics

    VNS Health (Manhattan, NY)
    …control, and reporting and analysis to meet National Committee for Quality Assurance ( NCQA ), Centers for Medicare and Medicaid Services (CMS) and New York State ... reporting and analysis to meet Client Contracts, National Committee for Quality Assurance ( NCQA ), Centers for Medicare and Medicaid Services (CMS) and New York State… more
    VNS Health (01/07/25)
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  • Analyst, Health Care QM

    CVS Health (Columbus, OH)
    …to be in compliance with National Committee for Quality Assurance ( NCQA ) and state and federal regulatory requirements. **Required Qualifications** -Act as ... collect all documentation required to meet National Committee for Quality Assurance ( NCQA ) standards and state and federal regulatory requirements -Work with health… more
    CVS Health (01/11/25)
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  • Manager, Business Compliance

    CVS Health (Columbus, OH)
    …**_**Candidate must reside in the EST or CST**_** **Business Compliance Manager, NCQA Accreditation** + Develop tactical and operational plans to achieve the ... followed concisely. + Ensure adherence to applicable laws, regulations, and NCQA accreditation standards by implementing compliance training programs and conducting… more
    CVS Health (12/14/24)
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  • Coordinator, Licensing and Credentialing

    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
    Somatus (01/10/25)
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  • Network Access and Adequacy Program Manager

    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
    CareOregon (01/10/25)
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  • HEDIS Abstractor II (Temporary)

    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
    LA Care Health Plan (01/09/25)
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  • Credentialing/Medical Staff Specialist (1.0)

    Billings Clinic (Billings, MT)
    …are scrutinized for compliance with National Committee Quality Assurance ( NCQA ) standards and national standards relating to credentialing verification ... Accreditation Hospital Organizations (JCAHO) and National Committee Quality Assurance ( NCQA ) accreditation standards relating to medical staff organization, credentialing… more
    Billings Clinic (01/07/25)
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  • Director - Quality Programs

    Independent Health (Buffalo, NY)
    …key quality performance requirements for Medicare Star, Medicaid QARR, and Commercial NCQA HEDIS and CAHPS reporting. They are accountable for planning and content ... Change management skills in a complex healthcare environment. + Expert knowledge of NCQA Health Plan Accreditation, HEDIS(R), QARR, and Medicare Star is required. +… more
    Independent Health (12/31/24)
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  • Medical Staff Services Specialist - Toledo…

    ProMedica Health System (Toledo, OH)
    …include: credentialing, privileging, corrective action, federal & state laws ( NCQA /JCAHO standards, Health Care Quality Improvement Act, HCFA), quality improvement ... and interpretation and application of medical staff bylaws, JCAHO standards, NCQA standards, state and federal regulations relative to medical staff organization,… more
    ProMedica Health System (12/25/24)
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  • Medical Director, Behavioral Health (Part Time,…

    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
    Magellan Health Services (12/24/24)
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  • Credentialing Specialist

    Penn Medicine (Philadelphia, PA)
    …Health, The Joint Commission (TJC), and the National Commission Quality Assurance ( NCQA ). The Credentialing Coordinator will maintain and verify all aspects of the ... in compliance with all accreditations (TJC, CMS, PA DOH, NCQA ), federal, state and Penn Medicine requirements. + Examine...and Regulations, Medical Board Policies, CMS, DOH, TJC, and NCQA standards and other relevant materials in order to… more
    Penn Medicine (12/20/24)
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  • Analyst, Quality Interventions/QI Compliance…

    Molina Healthcare (IA)
    …measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. ... as needed to ensure reports meet required timelines, business needs, and NCQA or other regulatory requirements. + Performs qualitative and / or quantitative… more
    Molina Healthcare (12/19/24)
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