- CVS Health (Lansing, MI)
- …& procedures in accordance with applicable regulatory and accreditation standards (eg, NCQA , URAC, state and federal standards and mandates as applicable) + Serve ... as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking + Ensure implementation and monitoring of best practice approaches and innovations to better address the member's… more
- Henry Ford Health System (Detroit, MI)
- …in compliance with the accrediting and regulatory agencies (ie The Joint Commission, NCQA , URAC, HFAP) in regards to credentialing while developing and maintaining a ... working knowledge of the statutes and laws. + Improves professional growth, knowledge of job to maintain efficiency and effectiveness of the CCS by participating in professional organizations, attending seminars and reading journals and publications addressing… more
- CVS Health (Lansing, MI)
- …management, case management, disease management. + Experience with URAC and NCQA accreditation requirements + Experience collaborating with legal counsel to help ... advise internal and external customers **Education** + Bachelor's degree preferred or a combination of professional work experience and education. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is:… more
- Henry Ford Health System (Bingham Farms, MI)
- …bid process. Ensures compliance with all CMS, State Medicaid Program, and NCQA pharmacy related regulations and reporting requirements. + Works with key stakeholders ... to develop innovative programs and services, including but not limited to Sales and Marketing, Finance, Quality Improvement, and Clinical Services. + Provides direction and input to cross-functional teams across the High-value Pharmacy Enterprise (HVPE) to… more
- Evolent (Lansing, MI)
- …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
- CVS Health (Lansing, MI)
- …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
- Molina Healthcare (Detroit, MI)
- …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
- Henry Ford Health System (Jackson, MI)
- …in compliance with the accrediting and regulatory agencies (ie, Joint Commission, NCQA , URAC, HFAP) in regards to credentialing while developing and maintaining a ... working knowledge of the statutes and laws. Coordinates annual projects relative to the medical staff and performs bookkeeping activities for the medical staff. Work closely with and maintain close communications with physician quality, medical staff leaders,… more
- Corewell Health (Grand Rapids, MI)
- …and ensuring they are completed in a timely manner in accordance with NCQA & CMS requirements + Recognizes customer concerns, grievances, and appeal rights resolving ... or escalating to the proper channels to achieve positive outcomes promptly + Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as corporate values and codes of… more
- CVS Health (Lansing, MI)
- …compliance and business leaders. **Core duties:** + Partner with Medicaid Care Management, NCQA , Compliance and Audit leads to analyze and support performance of all ... relevant markets. + Works to establish and maintain collaborative relationships by fostering excellent customer response and appropriate problem resolution. + Collaborates with leadership throughout the organization to develop and implement program strategies… more