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Across its 85-year history, first as a pioneer of the test prep industry, then as an early online education leader, and now as a global education provider, Kaplan has been recognized for expanding educational access and improving student outcomes through innovative uses of technology, instructional design, and learning science.
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May participate in health plan credentialing operations and clinical aspects of the credentialing program and provider services support. Identifies and communicates new opportunities in utilization management, provider contracting or other areas that would enhance outcomes and the reputation of the organization.
$196,000 - $319,500 a yearFull-timeExpandUpdated Today - UpvoteDownvoteShare Job
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Promotes provider understanding of utilization management and quality improvement policies, procedures and standards. Periodic travel to a different office location, provider office, or other meeting location.
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Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws.
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Quality ImprovementHelps develop, implement and review adherence to a quality improvement program that assesses the following items: continuous quality improvement (clinical and service indicators), utilization management, standard practice guidelines, peer review, incident reporting, provider satisfaction, patient satisfaction, patient grievances, policy and procedures, nurse practitioner / physician assistant protocols, credentialing, internal audits, and patient education.
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Knowledge of the health insurance industry, state and federal regulations, provider reimbursement methods and evolving accountable care and payment models. Minimum Requirements Demonstrated competency working with hospitals, provider groups or integrated delivery systems to effectively manage patient care to improve outcomes.
$196,000 - $319,500 a yearFull-timeExpandUpdated Today - UpvoteDownvoteShare Job
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Notifies appropriate insurance personnel to pre-certify surgeries or tests ordered by the physician or other health care provider, which require pre-certification by the insurance company. If you are passionate about changing lives, we are looking for you Minimum Education (CMA) High School Diploma or equivalent required for CMA Basic Life Support Required Minimum Education (PSR) High school diploma or equivalent required Graduate from a medical office assistant program preferred Licenses/Certifications (CMA) Completion of an accredited Medical Assisting Program required Current credentialing (certification/registration.
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Proven ability to develop and maintain positive working relationships with community and provider partners. SummaryLocation: Seattle, WA; Salt Lake City, UT; Medford, OR; Coeur d'Alene, ID; Lewiston, ID; Boise, ID; Burlington, WA; Bend, OR; Remote; Portland, OR; Utah; Yakima, WA; Tacoma, WA; Oregon; Spokane, WA; Washington; Idaho; Pocatello, ID; Salem, ORType: Full time.
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For NPs: Graduate of an accredited master’s degree in Nursing (MSN) program and board certified through the American Academy of Nurse Practitioners (AANP) or the American Nurses Credentialing Center (ANCC), Adult-Gerontology Acute Care Nurse Practitioners (AG AC NP), Adult/Family or Gerontology Nurse Practitioners (ACNP), with preferred certification as ANP, FNP, or GNP.
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Actively promote the CCM program in assigned facilities by partnering with key stakeholders (i e : internal sales function, provider relations, facility leader) to maintain and develop membership growth.
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Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, CCM staff and other provider groups. Manage both medical and behavioral, chronic and acute conditions effectively, and in collaboration with a physician or specialty provider.
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The APC will do an initial medication review, annual medication review and a post-hospitalization medication reconciliation. As an CCM Nurse Practitioner/ Physician Assistant per diem you will provide care to Optum members and be responsible for the delivery of medical care services in a periodic or intermittent basis.
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Collaborate with Provider Relations staff for timely completion of audits and provider profiles for re-credentialing purposes Qualifications: Graduate of accredited school of nursing, RN, 2 years of experience in quality management monitoring activities and/or credentialing/ recredentialing reviews.
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The Advanced Practice Provider will be responsible for caring for patients, maintaining accurate and current patient records and scheduling and administering follow-up appointments as required.
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Routinely partners with upstream and downstream functional areas, including recruiting, provider compensation, credentialing and scheduling, to align on contract requests and related process and data needs.
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provider credentialing jobs
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