- Humana (Tallahassee, FL)
- …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
- Molina Healthcare (St. Petersburg, FL)
- …adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA -compliant ... and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. + Reviews quality referred issues, focused… more
- University of Miami (Miami, FL)
- …comprehensive understanding of relevant accreditation standards (eg, The Joint Commission, NCQA ), state and federal regulations, and medical staff bylaws. The Senior ... with The Joint Commission (TJC), National Committee for Quality Assurance ( NCQA ), CMS, state licensing boards, and other relevant regulatory and accreditation… more
- Molina Healthcare (Orlando, FL)
- …and state delegated activities, ensuring compliance with State, Federal, NCQA and Molina delegation standards and requirements. Provides delegation oversight ... delegation audit assessment tools as necessary to comply with state, federal, NCQA , and any other applicable requirements. + Assists with chairing monthly meetings… more
- Molina Healthcare (Orlando, FL)
- …+ Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation. + Provides ... review and abstraction + Intermediate knowledge of HEDIS and NCQA **PR** **E** **FE** **R** **RED E** **X** **PE**...managed care experience. + Advanced knowledge of HEDIS and NCQA . **PR** **E** **FE** **R** **RED L** **I** **C**… more
- Molina Healthcare (Miami, FL)
- …measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. ... provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities. +… more
- Molina Healthcare (Jacksonville, FL)
- …calls from members, providers, and pharmacies to meet departmental, State regulations, NCQA guidelines, and CMS standards. + Provides coordination and processing of ... requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA , and CMS policy/guidelines, and any other necessary information to providers,… more
- Molina Healthcare (Tampa, FL)
- …and documents delegation assessments as necessary to comply with state, federal, NCQA , and any other applicable requirements. + Prepares status reports from ... Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team. **JOB… more
- Highmark Health (Tallahassee, FL)
- …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
- Cleveland Clinic (Weston, FL)
- …states Licensing Board. + Current DEA License or DEA designee as required by NCQA . + Basic Life Support (BLS) through the American Heart Association (AHA) required. ... + Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) through the American Heart Association (AHA); or Neonatal Resuscitation Program (NRP) through the American Academy of Pediatrics (AAP); or Advanced Trauma Life Support (ATLS)… more