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Under the general direction of the Vice President of Physician Practices is responsible for planning, organizing, and directing all functions of the Licking Memorial Health Professionals quality improvement programs based on current knowledge of NCQA standards, P4P industry standards, quality improvement methods and all Licking Memorial Health Professionals (LMHP) quality improvement/incentive plans.
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Top candidates will have health plan experience developing quality programs centered around NCQA and other regulatory compliance measures. Top candidates will have health plan experience developing quality programs centered around NCQA and other regulatory compliance measures.
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Awareness of NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems. 2+ years of clinical experience, primary care, home-based medical care, geriatrics or palliative care of emergency/urgent care.
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2+ years of clinical experience, primary care, home-based medical care, geriatrics or palliative care or emergency/urgent care. Comfortable with basic procedures of nursing care, including IV placement, blood draws, injections, foley catheters, nasal packing, wound care, etc.
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The walk-in/urgent care center is part of a multidisciplinary Level 3 NCQA Patient-Centered Medical Home providing all aspects of care for women of all ages. Providence is just 45 minutes from Boston, making it easy to go north for the theatre, ballet or world-championship sports or to Cape Cod for a peaceful day of fishing or sailing or antiquing or to the sparkly casinos of neighboring Connecticut or to Newport RI to tour the famous mansions, or enjoy a relaxing beach day.
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Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation. Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation. Required Job Qualifications: *Bachelor Degree; one year of business experience, law enforcement experience, or regulatory agency experience may substitute for each year of college.
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Experience in HEDIS/Quality, NCQA, state reporting and analytics, is important to this position. PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification and/or comparable coursework desired.
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Develop and maintain reporting systems, analytical processes or other tools to support Quality and Clinical Performance, key benchmarks and improve Quality outcomes, i.e., HEDIS, NCQA, CAHPS, PIPS and state regulatory requirements.
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Experience completing HEDIS measure validations, knowledge of HEDIS software tools, and working with NCQA on HEDIS measure questions. Experience working with NCQA, CMS, and State regulatory agencies; knowledge of NCQA vendors.
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Also performs general administrative duties in accordance with TJC, CLIA, HIPAA, NCQA and government standards, as well as company policies and procedures. Principal AccountabilitiesUnder the overall supervision of the Practice Manager, direct clinical supervision of the physician and within established policies and procedures, the incumbent performs the following functions:Delivers appropriate care to patients, at a proficient level; is cross-trained to competently care for patients from multiple services/specialties such as: CCC, Urgent Care, Urology, OBGYN, Mental Health, and other specialty clinics.
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Assesses patient/member per CMS Condition of Participation (COP) or National Clinical Quality Association (NCQA) standards. Ensures a plan of care is developed and maintained for members receiving care management services consistent with COP/NCQA and department standards.
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Practice in an NCQA Level 3 PCMH community-based practice. Close to the Bronx Park, the New York Botanical Gardens, and the Bronx Zoo. Practice in an NCQA Level 3 PCMH community-based practice.
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We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. As a team member of our Landmark product, we help bring home-based medical care to complex, chronic patients.
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Oversee care management functions and ensure consistency and compliance with clinical policy, procedure and best practices, including regulatory and contractual agreements as well as NCQA accreditation requirements.
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Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required. Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is required.
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