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NCQA Accreditation and QI Compliance : Manages the execution of NCQA accreditation surveys, expands PCMH certification to all clinics, and UDS (Uniform Data System) compliance operations.
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Knowledge of National Committee for Quality Assurance (NCQA) / Utilization Review Accreditation Commission (URAC) standards. CNSI and Kepro are now Acentra Health! Knowledge of National Committee for Quality Assurance (NCQA) / Utilization Review Accreditation Commission (URAC) standards.
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Experience with NCQA or other health plan accreditation standards, State and Federal laws, regulations, policies and practices for the administration of a Medicare Advantage special needs plan.
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Ability to meet accreditation and quality standards including, but not limited to NCQA, PCMH, HEDIS through following defined procedures to assess, intervene and document interactions. Manage person-centered care plans and member contact in compliance with all agency requirements, internal protocols, and accreditation standards.
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Demonstrated expertise in NCQA accreditation and related processes, especially Health Equity Accreditation or Multicultural Healthcare Distinction. Responsible for leading all NCQA Health Equity Accreditation work for Humana's Medicaid markets.
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Interprets contractual requirements including federal and state regulations and NCQA. Mentor and coach new/more junior staff to educate and inform on accreditation and regulatory standards as well as policies on credentialing and re-credentialing.
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The CCO is responsible for maintaining NCQA and/or URAC accreditation and any other accreditations required by Community. This includes direct responsibility for compliance, audit, fraud waste and abuse programs, accreditation, and the Company's Special Investigative Unit (SIU.
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Represents the scope of health plan/Provider relationship across such areas as financial performance, value-based payment incentive programs, quality and clinical management, population health, data sharing, claims payment/billing inquiry resolution, documentation, and coding, NCQA accreditation, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, enrollee experience, market growth, provider experience and operational excellence.
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Experience with NCQA accreditation survey requirements for health plan with HEDIS specifications, and with state and federal health care regulations applicable to managed care organizations.
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Provides oversight to the HEDIS and CMS Stars data collection process and local performance strategy, CAHPS improvement strategy, and drives Health Plan accreditation activities as well as quality rating improvement initiatives and other clinical interventions for the local health plan.
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Knowledge of accreditation standards for managed care organizations, e.g., NCQA, and Federal, State, and local requirements for FQHC and managed care organizations preferred. Also included under the oversight of the CFO is Revenue Cycle Management, Patient Experience, Accounts Payable management, Budget & Forecasting, Payroll, Cash Management, General Ledger, Account Reconciliation, Population Health and Grants Management, Health Resource and Services Administration (HRSA) grant reporting as related to the Electronic Handbook (EHB) and Uniform Data Systems (UDS), Medicare and Medicaid Cost Report activities.
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Ensures that case documents are audit-ready and grievances and appeals are handled per QUEST Integration, CMS, NCQA, and other accreditation and regulatory requirements and AlohaCare standards.
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Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA)standards a plus. the organization has one the largest Gastroenterology Prior Authorization program in the country, providing you a chance to impact clinical change on a nationwide scale while supporting patients in all U.S. time zones.
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Ensure that all NCQA and other accreditation standards are met; ensure compliance with accurate coding and documentation standards, STAR, HEDIS measures. Ensure that all NCQA and other accreditation standards are met; ensure compliance with accurate coding and documentation standards, STAR, HEDIS measures.
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Oversee that all NCQA and other accreditation standards are met. Experience in medical utilization management, medical quality assurance, quality improvement techniques, risk management and a value-based care environment.
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