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This position also performs general administrative duties in accordance with CLIA, HIPAA, NCQA and government standards, as well as company plicies and procedures. Follow-up with patient as appropriate to ensure compliance with recommendations, medications, lab/x-ray results, special visits, PCP visits, dieticians, diabetes educators, etc.
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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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Maintain current knowledge of Joint Commission, NCQA, and other regulatory body requirements. Responsible for obtaining and maintaining an EPIC training status of Proficient Self-Study or higher for the Clinical Data Model in order to develop effective reports.
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Prepare credentialing audit reports tracking and trending auditor findings and assist in the formulation of staff training guides, policies and procedures Manages multiple concurrent audits, plan audits and related projects ensuring all audit tools comply with NCQA, TJC and CMS requirements Coordinates the credentialing and re-credentialing process for assigned providers.
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Maintains and assures implementation of all Joint Commission/Patient Centered Medical Home, and NCQA certification requirements. Directly supervises Director of RW Clinical Services, Staff Physicians, Mid-Level Providers, Psychiatrist, and Director of Nursing, and Behavioral Health Director.
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Today the Network serves more than 20,000 patients annually and is an NCQA certified Patient-Centered Medical Home and recognized by HRSA as a National Quality Leader for Behavioral Health. Minimum of two (2) years' experience as a therapist and a current license to practice in Pennsylvania as a Licensed Clinical Social Worker, Licensed Professional Counselor, Licensed Marriage and Family Therapist, or Psychologist.
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FQHC in the Harrisonburg, Va area recognized by NCQA as a Patient Centered Medical Home with Behavioral Health Distinction, in all care delivery locations is seeking an MD/DO clinical provider to also serve as a member of the leadership team.
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Strong understanding of healthcare quality measures, including NCQA HEDIS measures, measures derived from EHR and other standardized datasets, administrative data, and public health databases. Manage the process of NCQA certification for HEDIS measures, including data collection, submission, and validation.
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Assists in the identification, planning and execution of strategies that drive and support corporate objectives, ensures compliance with the DHCS, DMHC and CMS regulatory requirements and NCQA accreditation requirements for health plan and health equity accreditation.
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As part of the Care Team, understands the NCQA Patient Center Medical Home Standards and expectations. We are both a Federally Qualified Health Center (FQHC) and a Community Mental Health Center (CMHC.
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Experience: 3-5 years of Program and/or Project management experience, with a focus on Quality/HEDIS, NCQA, and operational process improvement. Certifications: PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, or comparable coursework desired.
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Medical Assistant Certification or LPN or GPN that must pass the MO NCLEX exam within 90 days of graduation required. MA brings patient back from the waiting room and completes intake including vitals, medication reconciliation, medical history, and Quality Measures in the EMR.
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Both practices are committed to providing high quality care to our patients and are a NCQA recognized Level Three – Patient Centered Medical Home and designated Rural Health Clinic. We have a strong, dedicated group of physicians and APPs in both practices including 6 internists, 5 family medicine physicians, and 8 APPs. In addition to providing general primary care we have offer specialized care in several areas including addiction medicine, integrative medicine, cardiac testing supervision, and an array of practice and hospital based procedures.
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Champion process improvement initiatives, organizational change management, and other key business processes. Additionally, you'll have the opportunity to collaborate with external vendors, oversee system analysis, and drive process improvements, all while focusing on effective program management.
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CMS, TJC, NMDOH, NCQA, OCR, NHSN, OSHA, CDC, and HIPAA) Provide direction to the medical staff credentialing process and education process to ensure compliance with HIPPA, medical staff bylaws, TJC, CMS, and NCQA and other regulatory standards and initiatives.
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