- Whitney M Young (Albany, NY)
- …with local, state, and federal regulation, ie DHHS HRSA and NYSDOH, and all accreditation standards (eg Joint Commission and NCQA -PCMH). Adheres to the National ... Be a part of the mission at Whitney Young Health (WYH) to provide high quality healthcare that is affordable and accessible to our diverse community. WYH has a… more
- Integra Partners (Troy, MI)
- The Quality & Accreditation Specialist is responsible for coordinating and maintaining accreditation activities for the Utilization Management (UM) and ... Credentialing departments. This includes supporting NCQA accreditation , implementing quality monitoring initiatives, conducting internal reviews, and… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …or 3-5 years of experience in a health care related field preferred. + NCQA accreditation experience is preferred. + Excellent communication skills with ability ... Health Plan in Wausau, WI is seeking a RN QUALITY IMPROVEMENT SPECIALIST to join our ASPIRUS...Director of Operations to develop and implement a cohesive Quality Improvement Program that supports NCQA , HEDIS… more
- Molina Healthcare (Rockford, IL)
- …key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. ... **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality Interventions / QI Compliance contributes to one or more of these quality improvement… more
- Highmark Health (Pittsburgh, PA)
- …respect to regulatory requirements and corporate policies/procedures. (Ex: operational audits, quality improvement audits, accreditation mock audits, etc.) + ... activities are compliant with regulatory guidelines/agencies, including but not limited to: NCQA , CMS, DPW, and DOH. Supports the integration of new vendors and… more
- Henry Ford Health System (Jackson, MI)
- …understanding of medical staff credentialing and regulatory requirements. Experience with accreditation standards (eg, Joint Commission, NCQA , URAC, HFAP). ... Credentialing Specialist - Medical Staff Affairs - Days Location:...medical staff meetings, and ensuring compliance with regulatory and accreditation standards. The coordinator serves as a key resource… more
- Magellan Health Services (Albuquerque, NM)
- …description. Other Job Requirements Responsibilities Knowledge of National Committee for Quality Assurance ( NCQA ) requirements. Ability to work independently and ... The Network Contract Specialist will be responsible for creating and maintaining...+ Rate updates + Letters of Direction (LODs) + NCQA /CAQH + Ensure compliance with internal standards and state-specific… more
- LA Care Health Plan (Los Angeles, CA)
- …Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance ( NCQA ) regulatory requirements. This position reviews pre-service ... Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department:...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- LA Care Health Plan (Los Angeles, CA)
- …(DMHC), Managed Risk Medical Insurance Board (MRMIB) and National Committee for Quality Assurance ( NCQA ) standards and regulations. (20%) Intakes, acknowledges, ... Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department:...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …licensing boards, as required by state and federal regulations, National Committee for Quality Assurance ( NCQA ) accreditation standards, and CPRC policies. + ... transform healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed… more
- University of Utah Health (Murray, UT)
- **Overview** The Health Plans Policy Specialist is responsible for researching, developing, and maintaining policies to ensure compliance with state and federal ... regulations, accreditation standards, and organizational objectives. This role conducts evidence-based...is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to… more
- Hackensack Meridian Health (Edison, NJ)
- …Office platforms. Education, Knowledge, Skills and Abilities Preferred: + Experience with NCQA PCMH standards and the accreditation process. + Experience with ... as a leader of positive change. The **Clinical Outcomes Specialist ** acts as a subject matter expert for key...use. This clinical resource will partner with the Ambulatory Quality and Patient Safety (AQPS) Team. This role is… more
- Trinity Health (Livonia, MI)
- …Medicare and Medicaid (CMS), The Joint Commission (TJC), and National Commission for Quality Assurance ( NCQA ) rules and regulations that govern credentialing and ... with applicable rules and regulations. Coordinates projects to improve the quality and efficiency of the credentialing and privileging process. **ESSENTIAL FUNCTIONS… more
- AmeriHealth Caritas (Manchester, NH)
- …quality team to implement communications that support improved member health outcomes, NCQA accreditation , and HEDIS measures. ; **Education & Experience:** + ... **Role Overview:** ;The Senior Provider Communications Specialist is responsible for managing all communication initiatives that impact internal and external… more
- Whitney Young Health Center (Albany, NY)
- …clinical champion for Community Prevention and Treatment Services program (CPTS) for NCQA PCMH principles. + Leads program clinical quality improvement ... activities and serves as SME for the Quality Improvement Committee + Supports established policies and procedures...federal regulation, ie, DHHS HRSA and NYSDOH, and all accreditation standards (eg, Joint Commission and NCQA -PCMH).… more
- WellSpan Health (York, PA)
- **General Summary** Provides day-to-day oversight, quality assurance, and guidance to Credentialing Coordinators. Ensures accuracy, timeliness, and compliance of ... credentialing, recredentialing, and enrollment activities in accordance with NCQA , CMS, and organizational standards. Develops and maintains Standard Operating… more
- Fallon Health (New Bedford, MA)
- …Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top ... health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, self-expression, and unique… more
- Whitney Young Health Center (Albany, NY)
- …with local, state, and federal regulation, ie DHHS HRSA and NYSDOH, and all accreditation standards (eg Joint Commission and NCQA -PCMH). + Adheres to the ... mission at Whitney Young Health (WYH) to provide high quality healthcare that is affordable and accessible to our...+ Works in conjunction with Digital Marketing & Communications Specialist to develop and execute promotional and social media… more
- Evolent (Helena, MT)
- …Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + Ensures documentation of all ... Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to...skills + Energetic and curious with a passion for quality and value in health care + Computer Proficiency… more
- University of Rochester (Albany, NY)
- …**Responsibilities:** GENERAL PURPOSE Participates in departmental activities to ensure quality in conducting, maintaining, and communicating the medical and allied ... of the department and collaborates with other team members to advance the quality of practitioners and patient safety of the facility. **ESSENTIAL FUNCTIONS** +… more
