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Maintains accountability for medical management functions to achieve the business and clinical outcomes for the health plan, meeting contract requirements, National Committee of Quality Assurance (NCQA) accreditation standards, and supporting initiatives with providers and members to manage cost of care.
$105,230 - $178,890 a yearFull-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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HEDIS Certified Measures® is a registered trademark of the National Committee for Quality Assurance (NCQA). HSAG's auditors are provided formal training in an assortment of healthcare-related topics, including health policy, clinical concepts, overview of analytic methods, data sources, and management techniques.
RemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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You will also provide clinical guidance on denial cases and ensure that all denial letters are written and issued according to internal policies and NCQA, health plan, federal, and state requirements.
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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. Participates, coordinates, and/or represents the Health Plan at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned.
Full-timeRemoteExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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This individual is responsible for oversight of the management of the medical and behavioral health credentialing/delegation functions for Network Health Plan in accordance with the NCQA and CMS standards.
ExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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NCQA recognized level 3 Patient Centered Medical Home and certified Rural Health Center in northern Vermont is looking to add an Otolaryngologist. All employees are eligible to participate in 401K Retirement Plan with employer contribution as well as utilize free membership to select local gyms.
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This position is part of the Enterprise HEDIS Analyst Team. It will be responsible for working with management and peers on the end-to-end HEDIS submissions for a grouping of contracts, audit activities, benchmarking, testing, measure validation, IDSS/PLD submission, state-required reporting, and health plan liaison.
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Drive the Improvement Plan program, maintain NCQA/WRAP accreditation initiatives, and participate in regulatory accreditation and inspection processes. Employee Assistance Program (EAP) including free counseling and health coaching.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Requires 3-5 years Care Management experience in a health plan or other managed care setting. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of NCQA (National Committee for Quality Assurance) standards.
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Dedicated to improving the health and well- being of patients, this position collaborates with the PCP, HBMC interdisciplinary teammates and consultants, and as needed, the health plan Medical Director and other health professionals, to develop and carry out patients’ goals of care in all phases of the patient journey.
Full-timeExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Knowledge of national quality organizations, including National Committee of Quality Assurance (NCQA) structure and standards and Health Plan Employer Data and Information Set (HEDIS) and National Quality Forum (NQF.
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Is responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan.
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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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This position is responsible for supporting and guiding the strategic needs of the company through the application of advanced data and analytics to diverse business initiatives, with a specific focus on Health Plan Employer Data and Information Set (HEDIS) data ownership and supporting the migration to the product-led model.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Serves as a liaison between population health platform, EMR and clinicians; prioritizes problems for effective and timely resolution, and develops/communicates resolution plan/approach and recommendations.
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