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Prepares reports on grievance and appeals as required by regulatory agencies, NCQA standards, and Plan management. Prepares and maintains case files and database for appeals and grievances in accordance with SHP, DHS, CMS, and DMHC requirements and NCQA accreditation standards.
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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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Charts member's treatment and progress in accord with state and NCQA regulations and in keeping with accepted community standards. Reports safety concerns to mandated reporting agencies Education PhD/PsyD/EdD in Clinical Counseling, Health or School Psychology from an accredited college or university.
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Ensures compliance with TJC, NCQA, MQSA, and other applicable local, state and national standards, requirements and regulations. Associate of Arts or Science degree in Radiologic Technology Diagnostic Ultrasound from an AMA approved school OR two (2) years of experience in a directly related field.
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Job Description:Under direct supervision, works as part of a team to maintain providers’ privileges and credentials in accordance with criteria set forth by the National Committee on Quality Assurance (NCQA) and Joint Commission (JC); provides related administrative and clerical support; other duties as assigned.
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Supervises daily operations and ensures staff provide the highest quality of care and are in compliance with the Nurse Practice Act, NCQA, TJC, and federal, state and local requirements. San Diego Mobil Health vehicle and NASSCO Shipyard Clinic.
$116,900 - $151,250 a yearExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Maintain knowledge of current regulatory NCQA, CMS, and DMHC requirements and industry trends. Oversees internal department meetings (Interdisciplinary care team (ICT) meeting, team huddles, etc.
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Expanding on its vision to be “Exceptional in Every Way,” FHCSD is also a national leader among community health centers through accreditation by the Joint Commission and designation as a Patient Centered Medical Home (PCMH) by the Joint Commission and the National Committee for Quality Assurance (NCQA.
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The Job This role, Network Compliance Auditor (FSR) Nurse, performs all aspects of a Facility Site Review (FSR), using regulatory requirements, to test, monitor, document and report the overall level of compliance of the First Tier, Downstream and related entities (FDR) to ensure compliance with all applicable requirements; SCAN, Federal, State and National Committee for Quality Assurance (NCQA) requirements.
$38.61 - $61.78 an hourExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Denial letter language must follow DMHC and NCQA format and be clear and concise. Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board -PREFERRED. H.S. Diploma or Equivalent; Bachelor's Degree; Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board; California Pharmacy Technician License (TCH) - CA State Board of Pharmacy.
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Reporting to the Manager, Delegation Oversight, the Delegation Operations Auditor, Senior is responsible for ensuring that delegates are compliant with all federal, state, and NCQA regulatory requirements with direct impact on the success of delegate compliance and organization oversight goals and objectives.
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Knowledge of NCQA, Medicaid, CCS etc. Well-versed with the health-plan space (Managed Care, MSO, or IPA experience optional) You get to work with the #1 Medicaid Health Plan in San Diego County.
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Maintains an in-depth and up-to-date understanding, of the Department of Healthcare Services (DHCS), Centers for Medicare and Medicaid Services (CMS), Department of Managed Healthcare (DMHC), and National Committee for Quality Assurance (NCQA) regulatory, contractual, and accreditation requirements related health plans and quality.
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Must have a minimum of 5 years clinical experience, beyond residency/fellowship Knowledge of applicable state and federal laws, URAC and NCQA standards a plus, and familiarity with automated processes and computer applications and systems is requiredNo nights, no weekends, not call.
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The Credentials Specialist will be responsible for performing primary source verification of education, training, experience, licensure, claims history, according to TJC, NCQA, CMS, AAAHC, state and federal accrediting standards.
$29.6 - $51.72 an hourFull-timeRemoteExpandApply NowActive JobUpdated 6 days ago
ncqa job in San Diego, CA
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