- Evolent (Hartford, CT)
- …providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. + Documents all ... communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in… more
- Evolent (Hartford, CT)
- …providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. + Documents all ... communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in… more
- Point32Health (CT)
- …appeal or grievance is compliant with the regulatory requirements set-forth by NCQA (National Committee for Quality Assurance), DOI (Dept of Insurance), CMS, DOL ... and any state or federal specific regulations that apply. + Review and interpret product and benefit designs for all lines of business according to State and Federal regulatory requirements + Manage the collection of documents and records (medical, claims,… more
- Evolent (Hartford, CT)
- …Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + Ensures documentation of all communications with medical ... office staff and/or MD provider is recorded in a timely and accurate manner. + Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Moses/Weitzman Health System (Middletown, 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
- The Cigna Group (Bloomfield, CT)
- …of Osteopathic Medicine. + Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management + Ability to commit to a set, weekly ... work schedule (Monday through Friday) + Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems + Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of… 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 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
- 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 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
- The Cigna Group (Bloomfield, CT)
- …healthcare quality standards, including HIPAA, JCAHO, and CMS as well as HEDIS, NCQA Health Plan Ratings, STARS, and CAHPS compliance. + Identify and mitigate risks ... related to healthcare quality and implement continuous improvement methodologies like Six Sigma or Lean Healthcare. + **Patient Experience:** + Implement and oversee a comprehensive patient experience strategy and develop strategies to enhance patient… more
- Moses/Weitzman Health System (Middletown, CT)
- …+ Leads the oral health/dentistry component of our Joint Commission accredited, NCQA designated Patient Centered Medical Home, with its focus on population health ... management, integration of all health care services and patient engagement. + Engages and directs peer review activity to ensure that standards of care are met and evidence based treatment is provided. + Provides clinical mentoring and support to staff in… more