- Evolent (Tallahassee, FL)
- …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
- Molina Healthcare (St. Petersburg, FL)
- …and processes are compliant with CMS and National Committee of Quality Assurance ( NCQA ) guidelines and Molina policies and procedures. + Participates in the daily ... workload of the department, performing Technician and/or Representative duties as needed. + Interviews with potential technician and service representative job applicants and provides hiring recommendations to Manager or Director. + Provides coaching for the… more
- AdventHealth (Tampa, FL)
- …and standards to ensure that credentialing operations are in compliance with NCQA credentialing standards and CMS. Works with AdventHealth Medical Group (AHMG), ... AdventHealth leadership, Managed Care Organizations and other departments within AdventHealth to fulfill its mission and goals. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally… more
- Molina Healthcare (FL)
- …and experience **PREFERRED EXPERIENCE:** * Knowledge of, and familiarity with, NCQA , CMS, and State regulatory submission requirements * Experience working in ... a cross-functional, highly matrixed organization * SQL proficiency * Knowledge of healthcare claim elements: CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** PMP, Six Sigma Green Belt, Six Sigma… more
- Cleveland Clinic (Vero Beach, 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)
- …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
- Sharecare (Tallahassee, FL)
- …+ Bachelor's degree preferred + 5+ years' experience in Care/Case Management + NCQA experience preferred + Certified Case Manager preferred + Prior management and ... supervision of a clinical team is preferred. + Health Plan experience is required. + Demonstrates computer competencies to include electronic medical records, word processing, spreadsheet, presentation preparation, and. Demonstrated ability to learn customized… more
- Cleveland Clinic (Stuart, 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
- Cleveland Clinic (Stuart, 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
- Cleveland Clinic (Stuart, 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