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High school diploma and 5-7 years’ experience as a Credentials Coordinator or credentialing capacity, in a medium to large size medical center with knowledge of medical staff function, credentialing, preparation of meeting minutes, CIHQ, Title XXII, NCQA, health plans and CMA.
$27.44 - $45.27 an hourFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Knowledge of the Medicare Advantage STARS program and NCQA technical specifications. Required Certified Professional Coder (CPC-I) certification, Certified Risk Adjustment (CRC) coder AAPC certification, and Certified Professional Medical Auditor (CPMA) certifications from AAPC (to obtain CPMA within 120 days from date of hire, if applicant does not currently possess.
$78,800 - $175,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Documents all medical evaluations, diagnoses, procedures, treatment, outcomes, education, referrals, and consultations consistent with NCQA (National. Specialty in Psychiatric/Mental Health Nursing and completion of an approved Adult, Child, or Family Nurse Practitioner Program, and/or completion of an approved Master's level Psychiatric Mental Health Nurse Practitioner's Program.
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Significant knowledge of federal and state regulatory requirements and accreditation standards (i.e., TJC, NCQA, DOC, DHS, DMHC, CMS, Title 22). The GME Clinical Credentials Coordinator (Medical Staff Coordinator) will initiate the appointment/credentialing and reappointment/ re-credentialing process, compiling and processing data in compliance with local, regional, state, and federal accreditation requirements, under minimal supervision.
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The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of NCQA (National Committee for Quality Assurance) standards.
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Experience in healthcare informatics and quality measures (eCQM, RAF, HEDIS, NCQA) preferred. Experience in healthcare informatics and quality measures (eCQM, RAF, HEDIS, NCQA) preferred. The CIS will work with the LANES Chief Medical Officer (CMO) and acts as a liaison between LANES and the client’s clinical team to implement and adopt the data platform and clinical quality use cases.
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Understand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA. Understand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA. You will be responsible for working with our network providers in improving quality of care through quality improvement activities that will encompass HEDIS, CMS Star Rating, and health plan quality performance reporting.
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Demonstrated knowledge of case management, discharge planning, transition of care, transfer coordination; Medicare, Medicaid, Title 22, NCQA, JCAHO, URAC, and other federal/state/local regulations.
$148,800 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. Provide in-service training to providers regarding HEDIS and CMS Star Measures. 3-5 years of IPA/MSO/HP or general healthcare experience.
$35ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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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. The successful candidate will be an M.D. or D.O. with a current, active, U.S. state medical license and board certified in Maternal - Fetal Medicine, recognized by the American Board of Medical Specialties (ABMS), with recent practice experience in direct patient care (within the past 18 months.
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Participate in ongoing discussions concerning data collections and analysis for HEDIS. Collect and collate appropriate data from IPA network providers for HEDIS measures. At least one (1) year of HEDIS related experience.
$30 - $35 an hourFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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In-depth knowledge of compliance and regulatory requirements, with specific expertise in NCQA standards desired. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
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Knowledge of CA regulatory guidelines, Medi-Cal guidelines, Medicare guidelines, NCQA requirements. The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the department.
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Creates diagnostically appropriate treatment plansDocuments 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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Ensures patient care staff provide the highest quality of care and are in compliance with the Nurse Practice Act, TJC, NCQA, federal, state and local requirements. Manages outpatient operations and through nurse supervisor(s) and/or assistant department nurse manager(s) is responsible for the delivery of nursing services and outpatient care which are integrated with business plans and meet or exceed cost, quality, clinical and utilization standards and performance measures.
$124,700 - $161,260 a yearFull-timeExpandApply NowActive JobUpdated Today
ncqa job in Glendale, CA
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