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Knowledge of National Committee for Quality Assurance (NCQA) / Utilization Review Accreditation Commission (URAC) standards. CNSI and Kepro are now Acentra Health! Knowledge of National Committee for Quality Assurance (NCQA) / Utilization Review Accreditation Commission (URAC) standards.
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As part of the Care Team, understands the NCQA Patient Center Medical Home Standards and expectations. We are both a Federally Qualified Health Center (FQHC) and a Community Mental Health Center (CMHC.
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Experience completing HEDIS measure validations, knowledge of HEDIS software tools, and working with NCQA on HEDIS measure questions. Experience working with NCQA, CMS, and State regulatory agencies; knowledge of NCQA vendors.
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Knowledge of NCQA and/or JCAHO Accreditation standards. Maintains and updates continuing medical education/ACLS credits and other training requirements. Maintains correspondence files and credentialing archival files.
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Demonstrated expertise in NCQA accreditation and related processes, especially Health Equity Accreditation or Multicultural Healthcare Distinction. Responsible for leading all NCQA Health Equity Accreditation work for Humana's Medicaid markets.
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Top candidates will have health plan experience developing quality programs centered around NCQA and other regulatory compliance measures. Top candidates will have health plan experience developing quality programs centered around NCQA and other regulatory compliance measures.
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Knowledge of NCQA Accreditation Standards in Provider Network an asset. Provider Network Management & PlanningUnder the direction of the Provider Network Council, performs ongoing assessment of Partnered Providers including metrics related to access, quality, cost, and efficiency.
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Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Act as subject matter expert for benefit plan and claims processing.
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Utilizes 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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Maintain thorough documentation of all provider meetings/interactions and member interactions for consistency and coordination and in compliance with National Committee for Quality Assurance (NCQA) standards.
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Experience with accreditation or regulatory audits, including NCQA, CMS audits. The Senior Compliance Analyst will be responsible for supporting the Compliance Officer in managing corporate compliance functions such as policy/procedure management, compliance hotline, conflict of interest, compliance training and regulatory change management.
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The Credentialing Coordinator is responsible for processing and completing the credentialing and re-credentialing functions of all providers in accordance with NCQA, state, and federal requirements.
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Nationally recognized as an NCQA Patient-Centered Medical Home. Recognized as a “National Model of Innovative Primary Care” by the Robert Wood Johnson Foundation. The opportunities: Two providers needed – GI Hospitalist and Gastroenterologist (outpatient.
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Experience: 3-5 years of Program and/or Project management experience, with a focus on Quality/HEDIS, NCQA, and operational process improvement. Certifications: PMP, Six Sigma Green Belt, Six Sigma Black Belt Certification, or comparable coursework desired.
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Experience in an MSO or ACO is preferred. Monitor the compliance hotline and compliance email address and work with the Compliance Officer to coordinate appropriate investigation and response to incoming reports.
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ncqa job in Des Moines, IA
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