• Medical Director (CT)

    Molina Healthcare (Albany, NY)
    …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
    Molina Healthcare (07/11/25)
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  • National Manager, Delegation Oversight

    Molina Healthcare (Buffalo, NY)
    …and state delegated activities, ensuring compliance with State, Federal, NCQA and Molina delegation standards and requirements. Provides delegation oversight ... delegation audit assessment tools as necessary to comply with state, federal, NCQA , and any other applicable requirements. + Assists with chairing monthly meetings… more
    Molina Healthcare (07/09/25)
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  • Health Plan Pharmacy Services Manager (SC…

    Molina Healthcare (NY)
    …for review. + Assures that activities and processes are compliant with NCQA guidelines and Molina policies and procedures and promotes best practice measures ... Quality Management and Health Education programs including, but not limited to, NCQA Accreditation, HEDIS, and Disease Management programs company wide. + Attends… more
    Molina Healthcare (07/24/25)
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  • Lead Abstractor, HEDIS/Quality Improvement (Remote…

    Molina Healthcare (Syracuse, NY)
    …+ 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
    Molina Healthcare (07/17/25)
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  • Case Manager, RN or Licensed Behavioral Health (SN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …Federal Employee Program (FEP) and National Committee for Quality Assurance ( NCQA ) accreditation standards, as appropriate to the member's case assignment. Uses ... of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the...requirements are being met, such as NYS DOH, CMS, NCQA , and HEDIS, serving as internal auditor within the… more
    Excellus BlueCross BlueShield (06/27/25)
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  • Senior Director, Quality Improvement

    Centene Corporation (New York, NY)
    …workflow. + Responsible for National Committee for Quality Assurance ( NCQA ) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) ... performance. + Ensure health plan is compliant and become/remain accredited with NCQA + Review and implement new technological tools and processes and fosters team… more
    Centene Corporation (07/24/25)
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  • Customer Service Representative, Medicare Pharmacy

    Molina Healthcare (Yonkers, NY)
    …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
    Molina Healthcare (07/23/25)
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  • Medical Policy Writer

    Evolent (Albany, NY)
    …meet the minimum standards for National Committee for Quality Assurance ( NCQA ), Utilization Review Accreditation Commission (URAC), and Company Policy across product ... of legislative/oversight bodies [e.g., National Committee for Quality Assurance ( NCQA ), Utilization Review Accreditation Commission (URAC), Centers for Medicare and… more
    Evolent (07/23/25)
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  • Medical Director

    Highmark Health (Albany, NY)
    …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
    Highmark Health (07/16/25)
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  • Managed Care Provider Enrollment Specialist

    Stony Brook University (Commack, NY)
    …initiatives. + As it pertains to credentialing, maintain current knowledge of NCQA , TJC, CMS and NYS laws and regulations. Review the following for ... and managing the Council for Affordable Quality Healthcare (CAQH) profiles. + Knowledge of NCQA , TJC, CMS and New York State Education Department and New York State… more
    Stony Brook University (07/09/25)
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