- UpvoteDownvoteShare Job
- Suggest Revision
Ensure compliance of all aspects of personal sales activities with internal policies, CMS, Department of Insurance, NCQA and all applicable Federal regulations. Trinity Health Plan of Michigan is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States.
Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Supports wellness and disease state management programs for Pharmacy Service and corporately which contribute to NCQA accreditation and ongoing quality improvement. Knowledge of medical terminology, health care coding systems such as ICD-10, CPT and HCPCS and HIPAA regulations.
ExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Pharm tech certificate may be substituted for two years of experience. Obtains and organizes drug utilization data, including patient specific and population-based data, in a manner which facilitates clinical review and decisions by Clinical Pharmacist Consultants.
ExpandUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
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.
RemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Preference for experience with Medicare Star ratings, Medicaid quality initiatives, and NCQA standards. Manage interface between vendor/consultant/client to ensure efficient coordination and implementation of coding, including appropriate oversight and monitoring of all PBM operations, data interfaces, and external communications.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
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.
ExpandUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Ensure compliance with healthcare regulations and accreditation standards, such as NCQA, HEDIS, and CMS. Health plan quality improvement experience including HEDIS, PQA, CAHPS, and NCQA.
Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
Responsible for regulatory (URAC/NCQA, CMS, state law) oversight and external representation of the department. PART-TIME Principal Clinical Program Pharmacist - Remote. Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree.
Part-timeRemoteExpandUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Physician Clinical Reviewer-Interventional Pain Management at Evolent Health in Boise, Idaho, United States Job Description Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions.
ExpandUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management. Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health.
ExpandUpdated 8 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Successful completion of the ECFMG and FLEX examinations. Full training in a residency program in the United States or Canada that is approved by the Accreditation Council for Graduate Medical Education (ACGME.
RemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
- Suggest Revision
NCQA, URAC and/or HEDIS accreditation experience strongly preferred. SummaryLocation: Renton, WA; Salt Lake City, UT; Medford, OR; Coeur d'Alene, ID; Lewiston, ID; Boise, ID; Burlington, WA; Bend, OR; Remote; Portland, OR; Utah; Yakima, WA; Tacoma, WA; Oregon; Spokane, WA; Washington; Idaho; Pocatello, ID; Salem, ORType: Full time.
Full-timeExpandApply NowActive JobUpdated Yesterday
FEATURED BLOG POSTS
Talent Mapping for the Rest of the Year
As you enter the next quarter of 2023, it's important to reflect on how well your talent strategy is aligning with your business goals. This is an opportune time to design or reassess your talent mapping approach, so your recruiting and hiring scheme going forward stays in line with this year's business goals.
How To Decorate a Cubicle for Inspiration & Productivity
You know the negative reputation cubicles have – dull, dreary, gray. How can you possibly be expected to sit in one every day and be your naturally productive, enthusiastic, and upbeat self? The answer lies in decorating your cubicle so it sparks creativity and feels welcoming. While this might seem impossible given the bland canvas you have to work with, take heart because it’s totally doable!
How do Employers Verify Education?
At any stage in your professional journey, you may come across an employer or a recruiter who asks to verify your educational credentials. This shouldn’t come as a surprise as 30% of candidates admitted to lying on their resumes, yet 79% of them never get caught. In fact, 85% of employers in the US who conduct background checks find that candidates have lied on their resumes or job applications.
How to Be More Articulate and Speak More Clearly
Have you ever had those moments when you're talking to someone and have no idea what they are saying? The best response you can muster up is a simple head nod or blind agreeance?
How to Ask for a Higher Starting Salary
Maybe you think you’ve finally found your dream job. Everything about it is perfect, except… the salary. Unfortunately, it just isn’t where you want it to be. So, should you give up and move on? Given all the effort you’ve already invested, it’s probably wise to try and negotiate a better salary before you do.
How to Pass a Personality Test with Flying Colors
Whether you’re applying for your first job or looking to move up the career ladder, personality tests aren’t usually the first thing we think about. But surprisingly, they can have a massive impact on how our future employers perceive us. In fact, a 2017 study by the Society for Human Resource Management (SHRM) has found that 32% of U.S. employers use personality tests when hiring for senior management positions, and 28% use them for middle management positions. Personality tests are also used for hourly workers and contractors, though less frequently.
10 Practical and Effective Strategies to Persuade Anyone of Anything
Learning how to persuade people is like a key that can unlock any door. Acing the interview for the job of your dreams. Getting the best deal on a new car. Closing a sale with a skeptical customer. All of these wins require a level of persuasiveness.