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Performs general administrative duties in accordance with JCAHO, CLIA, NCQA and government standards, as well as company policies and procedures. Key Responsibilities Performs visit chart preparation activities based on the daily scheduled appointments including diagnostic test results, emergency/urgent care reports, discharge summaries and consult/PCP reports are located in the medical record and accessible to the provider.
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Promotes and complies with NCQA PCMH standards of care. Performs CLIA waived testing as ordered by the provider. Supports provider with completion of electronic order entry. Obtaining accurate vital signs from the patient and reports abnormal findings to provider.
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Previous experience in a network development, provider recruitment or provider contracting. Conducts and manages ongoing audits of provider compliance with Magellan policies and procedures as well as contractual obligations for multiple customers.
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Knowledge of National Committee for Quality Assurance (NCQA) requirements. Experience with Provider recruitment and contracting. Knowledge of National Committee for Quality Assurance (NCQA) requirements.
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This position will work closely with the CM Director as well as internal and external stakeholders (including, but not limited to, key internal teams such as Population Health, Quality Improvement, Provider Network, Compliance and Medicare/Medicaid Administration, along with providers and community partners) to develop and lead CM initiatives in accordance with CMS, OHA and NCQA requirements.
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Knowledge of health plan regulatory requirements, including CMS, NCQA, and the DOH. -In partnership with internal stakeholders and our network providers, this position will champion provider practice transformation in support of strategies to increase access and availability of care, including physical and BH integration and other alternative payment models.
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Knowledge of documents and their contents used in provider contracting, including applications, agreements, fee schedules, and credentialing. Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements.
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Ensure compliance of pharmacy benefit management activities with appropriate regulatory (OCI, DOI, CMS, DHS) and accreditation (NCQA) organizations in collaboration with internal areas including assessment of new government program requirements and determine appropriate compliance strategies and implement.
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Well versed in the use of the Cactus Database CPCS (Certified Provider Credentialing Specialist) Review and understand the Medical Staff Bylaws of each CH Facility Review and understand the Joint Commission Standards Review and understand the NCQA Standards.
$27 - $30 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Must be able to perform the professional, clinical and technical competencies of the advanced practice provider role (PA or APRN) in the assigned occupation health setting. 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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Demonstrated knowledge of operations and healthcare management; NCQA, CMS, and other local, state, and federal regulations. Interacts with Member Services, Provider Relations, Quality Improvement, and Finance to identify utilization trends.
$75,780 - $148,930 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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SAC Health System is recognized as a Level-3 Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA). This whole-person, full-scope, team-based approach is what makes SAC Health System the provider of choice for patients.
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Assists in obtaining and maintaining NCQA PCMH recognition; The PSR assists in coordination of healthcare and patient-centric care management by serving as patient and provider advocate by answering all specific questions, while educating and guiding patients through the complicated process of healthcare.
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Advanced knowledge of HEDIS and NCQA. As needed, may collects medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
Starting at $17.85 - $38.69 an hour depends on education, experienceFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Knowledge or experience with NCQA PCMH model is preferred. Must have a minimum of 2 years’ experience practicing as a Advance Practice Provider. Must be able to work as part of a multidisciplinary team with constant collaboration within and across provider teams.
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