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Today the FPCN serves more than 20,000 patients annually and is a NCQA certified Patient-Centered Medical Home and recognized by HRSA as a National Quality Leader for Behavioral Health. FPCN does not provide H1B Visa Sponsorship.
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Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable. Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers.
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Ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. Knowledge of current NCQA/URAC standards strongly preferred. CNSI and Kepro are now Acentra Health.
$72,000 a yearFull-timeRemoteExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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E.g., NCQA, URAC, Pennsylvania Department of Health and Department of Insurance, ERISA, Act 68). e.g., NCQA, URAC, Pennsylvania Department of Health and Department of Insurance, ERISA, Act 68.
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Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems is helpful. Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs.
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Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Acentra seeks a Clinical Reviewer Immediate Advocacy (Remote) to join our growing team.
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Regulations, URAQ and/or NCQA standards, Case Management Society of. Performs non-medical research pertinent to the establishment, regulations, URAQ and/or NCQA standards, Case Management Society of.
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Knowledge or experience with NCQA PCMH model is preferred. Treat acute exacerbations of chronic conditions within the AbsoluteCare center, i.e. Lasix for CHF, IVF for Dehydration/Renal Failure, IV antibiotics for various infections, Nebulizer/Solumedrol for COPD/Asthma etc.
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Ensures day-to-day processes are conducted in accordance with NCQA, URAC, CMS, and other regulatory standards. Knowledge of current NCQA/URAC standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC, CMS, and other regulatory standards.
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We ensure Humana's policy remains in line with NCQA, URAC, and state requirements to maintain accreditation. Become a part of our caring community and help us put health first. Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company.
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Our experienced and compassionate family physicians care for patients in a level 2 NCQA certified medical home model. Our experienced and compassionate family physicians care for patients in a level 2 NCQA certified medical home model.
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Meet specified timeframes established by regulators (DHS, NCQA, DOH, and CMS). Process/review requests for durable medical equipment (DME), home care, home infusion, hospice at home, transportation, and outpatient rehab services such as occupational therapy, physical therapy, speech therapy shift care, and medical day care.
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Experience with both JCAHO and NCQA standards preferred. Experience with both JCAHO and NCQA standards preferred. Processes applications and performs primary source verification for applicants to the facilities and organizations of UPMC. Processes applications and performs primary source verification for reappointment and re-credentialing for practitioners who are members of the facilities and organizations of the UPMC. Maintains a current and accurate database of credentialing information.
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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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