- Molina Healthcare (Ann Arbor, MI)
- …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
- Humana (Lansing, MI)
- …Ensures best practice standards and the National Committee of Quality Assurance ( NCQA ) Care Management criteria are used to assist with developing the documentation ... state and federal regulations, state Contract requirements, Humana policies and NCQA standards. **Use your skills to make an impact** **Required Qualifications**… more
- Molina Healthcare (Grand Rapids, MI)
- …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
- Humana (Lansing, MI)
- …ensure Humana maintains compliance with MDHHS, National Committee for Quality Assurance ( NCQA ), Department of Health and Human Services (DHHS), CMS guidelines and ... Medicare regulatory requirements and National Committee for Quality Assurance ( NCQA ) standards. + Comprehensive knowledge of Microsoft Office applications including… more
- Highmark Health (Lansing, MI)
- …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
- McLaren Health Care (Flint, MI)
- …performing quality management activities in a managed care organization, including HEDIS, NCQA , including at least two (2) years' experience in a management with ... + Five (5) years progressive experience in a leadership role in group health plan operations. + Two (2) years' experience with accrediting entities such as NCQA . more
- Molina Healthcare (Grand Rapids, MI)
- …experience + 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 To all current Molina employees: If you are interested in applying for this position,… more
- Intermountain Health (Lansing, MI)
- …logging events and progress according to applicable regulatory requirements such as NCQA , CMS and State EQRO standards. + Coordinates and facilitates communication ... among the member/family/representative, members of the healthcare team, and other relevant parties (eg, other payers, Sales Team, Employer Groups, etc.) through interdisciplinary team meetings or other coordinated communication. + Contacts patient at… more
- Henry Ford Health System (Wyandotte, MI)
- …Assists in compliance with accrediting and regulatory agencies (ie CMS, TJC, NCQA , HFAP). Principle Duties and Responsibilities: . Coordinates the credentialing and ... privileging approval process. Processes and assigns files to team members for processing ensuring the timely and accurate review of applications for initial appointment, reappointment, and requests for privileges. . Works closely with medical staff leadership… more
- Evolent (Lansing, MI)
- …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