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Certified Provider Credentialing Specialist (CPCS) or Provider Enrollment Specialist Certification (PESC) preferred, but not required. Provides leadership and direction to the Physical Therapy, DME and Home Health enrollment staff informing them of new payer contracts, completion of their enrollment applications and keeping them apprised of NCQA, CMS, DHS, and military contractor rules and regulation changes.
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Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Serve as the IEHP Liaison between hospitals, IPAs vendors, outside agencies and provider to ensure effective communication and collaboration in an effort to meet the Member's treatment plan and goals.
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TrueCare is a federally qualified health center, recognized by the NCQA as having achieved the highest level Patient Centered Medical Home. With 13 locations around North San Diego and Riverside County, we offer comprehensive programs with a holistic, integrated approach, including primary care, behavioral health, dental, and women’s services.
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Education & Experience Undergraduate or graduate degree in social work (LSW) or licensed practical nurse (LPN) 3-5 years of Case Management experience preferred Medicare or Medicaid knowledge preferred NCQA or URAC experience preferred Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
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Under the direction of the practice physician and/or advanced practice provider (APP) and the supervision of the Nurse Manager (RN) and/or Nurse Supervisor (RN), the RN may provide direct patient care, patient triage (in-person and telephonic), assessment, planning, directing, and evaluating of a patient’s specific care plan and clinic visit.
$33 - $47.6 an hourInternExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Identifies knowledge deficits in the Provider Network and refers targeted providers to Provider Relations and Network Management for education, as appropriate. Complies with CMS, NCQA, ERISA and PA. Act 68, and other state and federal regulations and timeliness standards.
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All SSM Health Medical Group primary care practices are nationally recognized as NCQA Patient-Centered Medical Homes and provide exceptional care through evidence-based protocols, while coordinating and managing patient care across the continuum.
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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
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Clinic is one of two primary care practices at a critical access hospital that is recognized by NCQA as a Patient-Centered Medical Home and is also a certified Rural Health Center. Seeking Advanced Practice Provider for outpatient opportunity in northern Vermont.
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The Behavioral Health Clinical Quality Program Manager is responsible for developing, implementing, and monitoring Quality initiatives to improve HEDIS and execute quality strategic priorities across the organization in compliance with NCQA MBHO standards.
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ProHealth Physicians is nationally recognized as an NCQA Level III Patient-Centered Medical Home and has received CMS approval as an Accountable Care Organization. ProHealth Physicians is currently interviewing for a full-time BE/BC Internist for a multi-provider practice in New Haven County Connecticut.
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Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
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The CMO will also maintain accountability for the oversight of the Health Services division, including Pharmacy, Utilization Management, Care and Disease Management, Quality Improvement, Appeals & Grievances, Medical Policy and Provider Engagement and Clinical Transformation.
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License, Certification, Registration Licensed Clinical Social Worker (California) OR Licensed Marriage and Family Therapist (California) OR Licensed Professional Clinical Counselor (California) AND Licensed Professional Clinical Counselor Couples and Families Endorsement (California) within 24 months of hire National Provider Identifier required at hire Additional Requirements: Must be familiar with DSM-V as a means of diagnosis.
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The Advanced Practice Provider (APP) will play a pivotal role within the EVMS Department of Medicine, Hospitalist Division, with a focus primarily on night shifts. Documents all medical evaluation, diagnoses, procedures, treatments, outcomes, education, referrals and consultations consistent with NCQA, The Joint Commission, state regulatory standards and evidenced-based standards of care.
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