- Molina Healthcare (Grand Rapids, MI)
- …or cross-functional teams of subject matter experts, delivering on NCQA accreditation requirements. Plans and directs schedules, reporting, process improvement, ... + Directs accreditation work plans and timelines to meet NCQA and contractual deadlines. + Manages cross-functional teams and...teams and external vendors to ensure deliverables align with NCQA standards. + Oversees submissions to NCQA … more
- Molina Healthcare (Sterling Heights, MI)
- …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
- Integra Partners (Troy, MI)
- …are not limited to: + Deep knowledge of CMS, state Medicaid, and NCQA regulations relevant to Utilization Management (UM), Credentialing and Claims, with the ability ... audit preparation and mock reviews to ensure readiness for NCQA , CMS, Medicaid and external health plan audits +...a regulatory monitoring cadence (CMS updates, state Medicaid portals, NCQA updates, etc.) to track changes impacting operations +… more
- Highmark Health (Lansing, MI)
- …coordinates and maintains delegated credentialing program in accordance with GHP, NCQA , and all regulatory agency standards. This includes delegation program, ... oversight of credentialing delegates to ensure that the delegated entities meet all NCQA , DPW, and DOH, policies and procedures related to GHP's delegated program. +… more
- CVS Health (Lansing, MI)
- …and makes recommendation for improvement in closing gaps in care, to achieve NCQA HEDIS metric benchmarks + Helps to develop strategy and improve Auto Assignment ... Consumer Guide scores + Helps to develop and implement improvement strategy for NCQA Star rating + Works to help facilitate and improve Quality Withhold metrics,… more
- Molina Healthcare (MI)
- …+ 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
- Henry Ford Health System (Troy, MI)
- …or Milliman Care Guidelines(R) criteria preferred. + Knowledge of Medicare, Medicaid and NCQA guidelines and use of CMS website for research preferred. + Knowledge ... + Knowledge of inpatient and outpatient procedures and practices. + Knowledge of NCQA , CMS, DOL, ERISA and other regulatory body rule preferred. + Computer skills… more
- Intermountain Health (Lansing, MI)
- …applicable. As the Care Management Director of Trinsic, you will: + Lead NCQA Care Management Accreditation, Survey Process, and updated annual standard review for ... and oversight for compliance with government regulations, contractual requirements and NCQA accreditation + Eight years of professional progressive experience in… more
- Henry Ford Health System (Troy, MI)
- …practitioner qualifications relative to regulatory standards and guidelines including NCQA , CMS, MDCH and HAP's established standards; maintain credentialing files ... according to regulatory standards and guidelines including NCQA , CMS MDCH, and HAP's standards. + Assure all practitioner data is accurate and up-to-date in the… more
- Molina Healthcare (Warren, MI)
- …health plan state provider agreement, National Committee for Quality Assurance ( NCQA ), Centers for Medicare and Medicaid Services (CMS), policies and procedures, ... * Assists in preparation of documents for utilization management, care management, state, CMS, NCQA and other regulatory audits as needed. * Local travel of up to… more