- 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 (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 (Albany, 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 (Rochester, NY)
- …measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. ... provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities. +… more
- Molina Healthcare (Buffalo, 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …payments, and enrollment in accordance with MTM, Corporate Service strategy, NCQA , and legislative requirements. The Customer Care Advocate provides service for ... groups concerning our products, services and policies in accordance with MTM, NCQA , HIPAA, NYSDOH, CMS and other legislative requirements. + By utilizing appropriate… more
- Whitney Young Health Center (Albany, NY)
- …champion for Community Prevention and Treatment Services program (CPTS) for NCQA PCMH principles. + Leads program clinical quality improvement activities and ... ie, DHHS HRSA and NYSDOH, and all accreditation standards (eg, Joint Commission and NCQA -PCMH). + Adheres to the National Patient Safety Goals as defined by the… more
- 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
- Intermountain Health (Albany, NY)
- …per CMS Condition of Participation (COP) or National Clinical Quality Association ( NCQA ) standards. Ensures a plan of care is developed and maintained for ... members receiving care management services consistent with COP/ NCQA and department standards. + Coordinates and facilitates communication among the member/caregivers… more
- 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