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The ideal candidate will have: RN with valid and current NYS Nursing Licensure 4 plus years clinical experience in ambulatory care, community health or home health setting Long Term Support Services (LTSS) or Managed Long-Term Care (MLTC) UAS field RN experience preferred.
$40 an hourExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Provides leadership and consultation to GIM Associate Division Head for Clinical Affairs regarding quality initiatives to include but not limited to NCQA, CPC+, and other value-based programs.
$20,000 - $234,000 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Knowledge and experience with PCMH standards(NCQA/AAAHC/Joint Commission/BCBS). The Clinical Quality Director is a full-time role that will lead our quality department aligning goals and strategy with the organizational strategic plan and the mission of Covenant Community Care. The Clinical Quality Director champions clinical quality improvement and compliance across medical, dental, and behavioral health services lines through fostering a culture of innovation, collaboration, and excellence.
Full-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Knowledgeable of NCQA and ICE.Duties:Lead and supervise a team of utilization management nurses, providing guidance, support, and oversight. Serve as a resource and mentor for utilization management nurses, offering clinical expertise and guidance in complex cases.
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Manages the implementation of Behavioral Health Services policies, Behavioral Health Care Coordination processes and procedures, and NCQA standards for appropriateness of setting, quality and cost-effective care for all lines of business and for all continuums of care.
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Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry. The role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Knowledge of health plan regulatory requirements, including CMS, NCQA, and the DOH. Supports organizational accreditation efforts and regulatory review processes, including participation in key committees and quality improvement activities Performs activities in compliance with all applicable regulatory entities including NCQA, CMS, PID, and DOH, among others.
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Assesses patient/member per CMS Condition of Participation (COP) or National Clinical Quality Association (NCQA) standards. Current State Licensure as a Certified Social Worker (CSW) or Licensed Clinical Social Worker (LCSW.
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Comprehensive training & experience in all aspects of ART clinical lab technologies, tissue culture, Andrology, semen analysis, egg retrieval, assessment, and transfer, sperm and embryo cryopreservation and micromanipulation.
$112,000 - $144,870 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Education and Experience: Bachelor’s degree in a Quantitative Analysis, Business, Healthcare Administration, Statistics, Epidemiology, Economics or a related field and a minimum of five years of clinical analytics experience in a healthcare setting; or an equivalent combination of education and experience may be qualifying.
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Serves as database administrator and facilitates biannual MCG-IRR testing (Milliman Care Guidelines-Inter Rator Reliability) that is administered to clinical and medical director staff. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS.Responsibilities:Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS.Analyze, prepare, and distribute quarterly audit outcomes including error trends, to the Business Unit Directors.
$76,800 - $102,795 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Supports wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement. Obtains and organizes drug utilization data, including patient specific and population-based data, in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS.
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Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including NCQA Health Plan Accreditation, as well as NCQA LTSS Distinction.
Full-timeRemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Prepares reconsideration requests for Clinical Pharmacy Consultant review by obtaining and organizing appropriate documentation, including, but not limited to medical chart notes/reports and medication profiles.
Full-timeExpandApply NowActive JobUpdated 4 days ago
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