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Ensures that utilization management and case management programs timeframes are in compliance with local, federal and NCQA standards. Ensures that retrospective events, appeals, and grievances timeframes are in compliance with NCQA, EQRO, District of Columbia, Federal, and any other applicable standards.
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Know and comply with DaVita policies and procedures in accordance with State and Federal regulations for patient care and services (CMS, HIPAA, OSHA, or other governing agencies); Standards necessary to maintain organizational accreditation (such as NCQA); and, State or Federal regulations of Injury Prevention and Safety Training Program.
$133,700 a yearFull-timeRemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Ensures that contract requirements, accreditation standards (e.g. NCQA), state policies and federal policies are implemented specific to each Magellan client. Participates in preparation for NCQA and URAC certifications.
$360,500 a yearFull-timeRemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Molina's Quality Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities.
$97,362.61 a yearFull-timeRemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Ensure compliance with training needs and requirements based on NCQA, contractual, CMS, and other compliance requirements. The Sr. Director of Training will be responsible for driving and executing all aspects of clinical training across the organization.
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Responsible for 100% auditing and analyzing all applications for clarity, quality, and completeness of data in accordance with policies and procedures, Joint Commission, NCQA accrediting standards, and state and federal regulatory requirements.
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Administers and ensures care management programs meet compliance and regulatory standards as required by Centers for Medicare & Medicaid Services (CMS), DSNP Model of Care (MOC), Washington Health Care Authority (HCA), and/or National Committee on Quality Assurance (NCQA) for continued accreditation of the health plan, as well as state and federal regulations, quality metrics and evolving models of care.
$173,250 a yearFull-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU's policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
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Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation.
$338,800 a yearFull-timeRemoteExpandApply NowActive JobUpdated 30 days ago - UpvoteDownvoteShare Job
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You will participate in population health management and overall financial viability of the program. 8+ years of NP Experience; experience in population health, Primary/family care, and/or Nephrology Required.
$133,700 a yearFull-timeRemoteExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Thorough knowledge of regulatory (state and federal) agency requirements and professional practice standards to include CLIA, COLA, CAP, NCQA, AABB, local, state and federal regulations. Bachelors degree in medical technology, clinical laboratory science, chemical, physical or biological science from an accredited institution.
$118,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Perform and collect PSV (primary source verification) documentation for licensing, board certifications, proof of professional liability insurance, National Practitioner Data Bank (NPDB) and/or other sources as required based on NCQA standards, health plan requirements, and company credentialing policies.
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Partner with business leaders and Quality staff to assure Cambia’s clinical program and strategy planning, assessment and impact evaluation processes satisfy NCQA population health requirements.
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Maintain team performance according to National Committee for Quality Assurance (NCQA) standards including but not limited to appropriate provider and member documentation. Maintain team performance according to National Committee for Quality Assurance (NCQA) standards including but not limited to appropriate provider and member documentation.
$135,029 a yearFull-timeExpandApply NowActive JobUpdated 9 days ago
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