- 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
- CVS Health (Tallahassee, FL)
- …quantitative and qualitative data analysis to strategize and achieve operational targets for NCQA HEDIS and Medicare Stars * Provide analysis support for PIP reports ... to regulators, including statistical analysis of interventions and measure of impact of activities on performance **Required Qualifications** * At least 5 years experience in managed care, hospital, or similar healthcare environment * Must have statistical… more
- Molina Healthcare (Orlando, FL)
- …role. + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA . **PR** **E** **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** ... **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working… more
- Evolent (Tallahassee, FL)
- …Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + Provides clinical rationale for standard and expedited ... appeals. + 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. + On a requested basis, may function as… more
- CVS Health (Tallahassee, FL)
- …policy development, and corrective action planning. **Preferred Qualifications** + NCQA credentialing experience. + Familiarity with tools such as QuickBase, ... Excel, and provider data platforms. + Project management experience. + Strong analytical and data-driven decision-making skills. + Ability to influence and collaborate across all levels of the organization. **Education** + Bachelors degree preferred or a… more
- Cleveland Clinic (Port Saint Lucie, 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
- Evolent (Tallahassee, FL)
- …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 (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
- Evolent (Tallahassee, FL)
- …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 (FL)
- …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