- Evolent (Lansing, MI)
- …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
- Henry Ford Health System (Clinton Township, MI)
- …in compliance with the accrediting and regulatory agencies (ie, Joint Commission, NCQA , URAC, HFAP) in regard to credentialing while developing and maintaining a ... working knowledge of the statutes and laws. Coordinates the continuing medical education program and performs bookkeeping activities for the medical staff. Work closely with and maintain close communications with medical staff leaders, hospital administration… more
- Tenet Healthcare (Detroit, MI)
- …Knowledge of ECHO or other credentialing software preferred. 5. Knowledge of NCQA and JCAHO standards, NPDB guidelines and general licensing regulations preferred. ... 6. Basic knowledge of medical terminology desired. Job : Non-Clinical/Administrative Primary Location : MI-Detroit : Hospital/Facility : Detroit Medical Center Shared Services Job Type: : Full-time Shift Type: : Days : : Req ID: 2506001048 more
- Molina Healthcare (Warren, MI)
- …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
- Evolent (Lansing, MI)
- …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 (Lansing, MI)
- …+ 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