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Monitor updates related to Client Partner Services from NCQA, CMS, Joint Commission, etc. Integrate and advance continued collaboration with Navvis Practice Optimization Program, Care Coordination, Post-Acute Care Networks, Patient Assessments, Ambulatory Care Management etc.
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Positions in this function are responsible for direction and guidance on clinical quality improvement and management programs including NCQA Health Plan Accreditation, as well as NCQA LTSS Distinction.
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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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Knowledge of NCQA guidelines and standard practices. Adheres to NCQA policies and practices. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life.
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This position requires credentialing, following the National Committee for Quality Assurance (NCQA) guidelines. This position provides psychotherapy to patients and requires Park Nicollet to comply with the Minnesota Statute A. Additional Information: Position is for an Ambulatory Dietitian in the Bariatric and Medical Weight Management Program.
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Review credentialing applications and supporting documentation for completeness according to Company policies, CMS, and NCQA criteria and standards. Robert Half currently has an excellent opportunity for a highly skilled and motivated Data Entry Clerk in the Healthcare/NHS industry who is looking to start their career with us.
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Awareness of NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems. 2+ years of clinical experience, primary care, home-based medical care, geriatrics or palliative care or emergency/urgent care.
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Escalate as needed, any issues related to Analytics to request and ensure tracking of client-specific data intended to understand client business trends related to Care Continuum/Throughput Services This includes Emergency Department Utilization/Optimization, Inpatient Discharge Decisions, Inpatient Mortality, Utilization of Palliative Care, Hospice, Home Health, SNF/IRF/LTAC, and Advanced Home Services including Hospital at Home.
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Manage assigned member appeals and grievance cases from documentation, to investigation, and through resolution, ensuring the final disposition of a member's appeal or grievance is compliant with the regulatory requirements set-forth by NCQA, DOI, CMS, DOL and any state or federal specific regulations that apply.
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Primary function will consist of investigating and responding to security events as detected by endpoint, network and email-based security solutions leveraged by our customer Awareness of federal and state security-related legislation including HIPAA, PCI, JCAHO, NCQA.
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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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Knowledge of federal and state security-related legislation including HIPAA, PCI, JCAHO, NCQA. Knowledge of federal and state security-related legislation including HIPAA, PCI, JCAHO, NCQA. At HealthPartners we believe in the power of good - good deeds and good people working together.
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Educate staff on NCQA standards, guidelines and survey operations; assess new and proposed NCQA requirements for health plan impact. Coordinate survey submission, file review and follow-up; serve as primary contact and operations liaison with NCQA staff.
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Working knowledge of MCG, InterQual, and NCQA standards. Active and Unrestricted License as a Licensed Vocational Nurse (LVN) Review cases for medical necessity and apply the appropriate clinical criteria; to include, but not limited to Medicare criteria, Medicaid/Medi-cal criteria, Interqual, Milliman, or Health Plan specific guidelines.
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