- UpvoteDownvoteShare Job
- Suggest Revision
The Job This role, Network Compliance Auditor (FSR) Nurse, performs all aspects of a Facility Site Review (FSR), using regulatory requirements, to test, monitor, document and report the overall level of compliance of the First Tier, Downstream and related entities (FDR) to ensure compliance with all applicable requirements; SCAN, Federal, State and National Committee for Quality Assurance (NCQA) requirements.
$38.61 - $61.78 an hourExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
Starting at $161,914.25 - $315,732.79 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Awareness of NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems. Reports directly to the advance practice supervisor, HbMC physician pod leader, or AMD. 2+ years of clinical experience, primary care, home-based medical care, geriatrics or palliative care or emergency/urgent care.
Work from homeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Order and interpret appropriate tests including x-rays, labs, and EKGs to diagnose, prescribe and treat within the provider’s scope of practice and consistent with the standards of care. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
2+ years of clinical experience, primary care, home-based medical care, geriatrics or palliative care of emergency/urgent care. Comfortable with basic procedures of nursing care, including IV placement, blood draws, injections, foley catheters, nasal packing, wound care, etc.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems. Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
To ensure coders provide technical aspects of the assignment diagnostic and carried out in accordance with established standards and in compliance NCQA and other regulatory agencies, and Tenet policy.
Full-timeRemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The incumbent will function as a "data storyteller"- be able to translate data, provide meaningful insights and apply the analysis to guide the design, execution, and implementation of interventions to maximize performance outcomes for Medicaid and Medicare.
$75,870 a yearExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Implements HEDIS measure campaigns and other quality initiatives as directed by Corporate Health Services to ensure the highest standards of care and to promote the improvement of care management and delivery.
$40,000Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
As a team member of our Landmark product, we help bring home-based medical care to complex, chronic patients. Implements HEDIS measure campaigns and other quality initiatives to ensure the highest standards of care and to promote the improvement of care management and delivery.
$40,000Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
This is a Monday-Friday field position covering Hennepin, Ramsey, and Washington Counties, MN. There will be some on call responsibilities as well. Knowledge of CPT, ICD-10 and HCPC codes. Participation in clinical after hours on-call program on rotational basis.
Work from homeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Helpful but not required: an awareness of UM standards, NCQA requirements, CMS guidelines, and Medicaid/Medicare contracts and benefit systems. ● Familiarity with Medicare guidelines.
$220,000 - $320,000 a yearFull-timeExpandUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Nationally recognized criteria such as Medicare Local Coverage Determination, Medicare National Coverage Determination, Milliman Care Guidelines, InterQual, and Apollo Managed Care Guidelines/Medical Review Criteria.
Full-timeExpandUpdated 7 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Working knowledge of HMO standards, LTSS, and NCQA standards is preferred. Knowledge of Medicare and Medicaid HMO experience is preferred. Working knowledge of HMO standards, LTSS, and NCQA standards is preferred.
ExpandApply NowActive JobUpdated 3 days ago
ncqa medicare jobs
FEATURED BLOG POSTS
Explore Your Skill and Find the Best Way to Make Money From Home
When you just can’t stomach another drive-thru coffee on your morning commute, close your navigation app on your phone and search for easy ways to make money from home instead. With a computer and some niche skills, there are countless opportunities for you to earn a living from your couch. (Okay, fine, your home office.) Below, we’ll explore 30 different ways to make money from home, as well as a few “too-good-too-be-true" warning signs to know to keep you from booking the wrong remote gig.
Learn How to Respond to an Interview Request With Templates
Job interviews are an inevitable part of any job search. So, handling them well is key to building a fulfilling career. Regardless of whether you’re looking at a more junior role or strive for a role as a business executive, you need to maintain your professionalism every step of the way in order to stay in the game.
How to Write an Address Correctly: Explained with Examples
It's hard to imagine a scenario where a text or phone call just won't do these days. With communication at our fingertips, you may think learning how to write an address is a superfluous skill. But it's a skill that will come in handy when you need to fill out healthcare forms, ship a package, order food delivery, or even apply for new jobs.
What is Employment Participation Rate
According to economists, there are four factors of production that go into creating higher quality goods at lower prices. These are
How to Get Pay Stubs (From Previous Employee Also!)
Pay stubs are an important piece of document which shows your earnings in a given period, as well as any deductions made towards your health insurance or pension contributions. They’re also excellent for finding out how much your recent salary raise has bumped up your monthly net income.
How to Write a Job Description?
It might be tempting to overlook the importance of a well-written job description. After all, if you’ve posted job ads before and ended up with tons of resumes in hand, it’s easy to assume that this will always be the case, regardless of how your job ad reads. But, in reality, you really can’t take getting an influx of resumes for granted.
How to Get a W2 From Previous Employers
When tax time rolls around, the last thing you want to worry about is having to track down a W-2 from your former employer. Many times you won’t have to because the IRS requires companies to send these forms to all current and former employees who have earned more than $600 in the last year. Unfortunately, there are employers who don’t do what they’re supposed to. There are even times where something else may happen that prevents the W-2 from getting where it’s supposed to go.