- Humana (Hartford, CT)
- …Humana. **Role Responsibilities:** + Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and ... facilitating NCQA UM survey activities. + Works closely with operational...areas to prepare documentation and files for presentation to NCQA . + Advises operational leaders and frontline associates in… more
- Highmark Health (Hartford, CT)
- …coordinates and maintains delegated credentialing program in accordance with GHP, NCQA , and all regulatory agency standards. This includes delegation program, ... oversight of credentialing delegates to ensure that the delegated entities meet all NCQA , DPW, and DOH, policies and procedures related to GHP's delegated program. +… more
- Highmark Health (Hartford, CT)
- …telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA , URAC, CMS, DOH, and DOL regulations at all times. In addition to ... and provider determination notifications all while adhering to required compliance standards ( NCQA , URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all… more
- Moses/Weitzman Health System (New Britain, CT)
- …center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA , respectively. We deliver more than 600,000 patient visits per year from primary ... care hubs and community clinics across the state of CT, all connected by technology and common standards for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in practice, teaching, and research. Our Weitzman… more
- CVS Health (Hartford, CT)
- …processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, ... while adhering to company policy and procedures. * Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. Customer service experience, Knowledge of Medical Terminology **Education** * High School Diploma or GED… more
- CVS Health (Hartford, CT)
- …management, case management, disease management. + Experience with URAC and NCQA accreditation requirements + Experience collaborating with legal counsel to help ... advise internal and external customers **Education** + Bachelor's degree preferred or a combination of professional work experience and education. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is:… more
- Evolent (Hartford, CT)
- …Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + Aids and acts as a resource to Initial Clinical ... Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Prime Therapeutics (Hartford, CT)
- …Provides optimum customer service through professional/accurate communication while maintaining NCQA and health plan`s required timeframes. + Regularly reviews and ... monitors information on pended claims identified as outliers by internal and/or external analysis of pharmacy claims data. + Supports Intake call volume and order entry if necessary. + Determines eligibility for medication reimbursement based upon established… more
- Moses/Weitzman Health System (Stamford, CT)
- …center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA , respectively. We deliver more than 500,000 patient visits per year from primary ... care hubs and community clinics across the state of CT, all connected by technology and common standards for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in practice, teaching, and research. Our Weitzman… more
- Insight Global (Hartford, CT)
- …SQL Experience with GCP and Bigquery Insurance background Experience with HEDIS or NCQA null We are a company committed to creating diverse and inclusive ... environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard… more