- AdventHealth (Orange City, FL)
- …with the quality team and practice coaches to implement and maintain NCQA /PCMH standards. Participates in educational sessions to improve skills as appropriate ... Participates in the collection of quality data Assists clinical staff providers with providing patients with outside resources and materials Assists in identifying and documenting cultural and linguistic needs of patients Assists in identifying and documenting… more
- Molina Healthcare (Orlando, FL)
- …performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **Job ... Duties** + The Mgr, Clinical Data Acquisition uses knowledge, skills and technical expertise to manage the mission critical nature of the performance measurement data collection, reporting and monitoring process, including HEDIS, state-based measure reporting… more
- CVS Health (Tallahassee, FL)
- …common billing practices + Demonstrated understanding of Medicaid industry standards and NCQA requirements + Proficient in Microsoft Office tools + Strong analytical ... skills regarding HEDIS metrics and quality reporting + Articulate and professional communication skills, both verbally and written + An ability to travel (up to three days a week) across the assigned territory for in-person provider support + Valid driver's… more
- Evolent (Tallahassee, FL)
- …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
- Molina Healthcare (Jacksonville, FL)
- …4-years' experience in Credentialing. * Required knowledge of Medicaid, CMS, NCQA and other credentialing regulations. * Experience leading employees, preferably in ... a production-related role. * Demonstrated adaptability and flexibility to changes and response to new ideas and approaches. * Strong problem-solving skills including root cause analysis and prompt resolution. * Excellent interpersonal and communication skills… more
- Evolent (Tallahassee, FL)
- …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. + Participates in on-going training per inter-rater reliability process. + May assist the Senior Medical Director… more
- Monte Nido (Miami, FL)
- …providers and facilities. + Ensure all credentialing processes adhere to NCQA standards and meet payor-specific requirements. + Verify credentialing data accuracy ... and validity through thorough reviews and audits. + Understand and manage the requirements for maintaining, updating, and activating healthcare providers' and facilities' credentialing with payors. + Navigate payor portals, web-based applications, and… more
- CVS Health (Tallahassee, FL)
- …**Compliance & Quality** + Ensure digital products adhere to HIPAA, CMS, NCQA , and other relevant healthcare insurance regulations. + Partner with compliance and ... security teams to maintain data integrity, privacy, and security standards. **Performance Tracking** + Define KPIs and success metrics to measure adoption, satisfaction, and ROI. + Continuously monitor and optimize products post-launch to maximize value… more
- Highmark Health (Tallahassee, FL)
- …and privileging requirements of the Department of Health, Joint Commission, NCQA , URAC and other governmental requirements, and performs in accordance with ... these standards. Generates and maintains accurate documentation that may be reviewed and judged for acceptability by state and federal licensing agencies. Handles customer questions and complaints. **ESSENTIAL RESPONSIBILITIES** + Reviews medical staff and… more
- Evolent (Tallahassee, FL)
- …Experience with value-based care, utilization management, or regulatory reporting (eg, HEDIS, NCQA , Milliman). **To comply with HIPAA security standards (45 CFR sec. ... 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available… more