- 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …ability to practice medicine. + Knowledge of applicable state and federal laws, NCQA standards, and Utilization Management. + Demonstration of effective use of word ... decision-making, and problem-solving skills. + Knowledge of credentialing, quality, NCQA /HEDIS/CMS and/or Medicaid Star Ratings, and/or value-based payment programs… more
- WMCHealth (Hawthorne, NY)
- …for Medicare & Medicaid Services, National Committee for Quality Assurance ( NCQA ) in collaboration with WMCHealth Network Medical Staff Offices, accrediting ... requirements of various organizations which affect the credentialing process such as CMS, NCQA , New York State Education Department, and New York State Department of… more
- Apicha Community Health Center (New York, NY)
- …validity, and perform ongoing quality assurance of data and reports, including NCQA PCMH accreditation, HEDIS/QARR, UDS, and HIV Treatment Cascade + Validate data ... and CPT coding strongly preferred + Understanding of UDS, HEDIS, and NCQA PCMH accreditation quality standards + Excellent verbal and written communication skills;… more
- Excellus BlueCross BlueShield (Dewitt, 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
- SUNY Upstate Medical University (Syracuse, NY)
- …assure that Upstate University Hospital meets the standards set forth by NCQA (National Committee for Quality Assurance) for Ambulatory Adult Primary Care Clinics. ... ambulatory clinics. This position is responsible for ensuring that clinics meet NCQA requirements and ensures the program meets its stated objectives for successful… more
- Sharecare (Albany, NY)
- …+ 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
- MVP Health Care (Tarrytown, NY)
- …HEDIS, STAR, CAHPS measures is preferred. + Knowledge of and experience with NCQA requirements is desirable + Curiosity to foster innovation and pave the way ... for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction **Your key responsibilities:** + Adjudicate initial, reconsideration and appeal authorizations for Post-Acute Care requests additional… more
- MVP Health Care (Rochester, NY)
- …criteria (eg, InterQual, MCG) and relevant regulatory/accreditation requirements (eg, CMS, NCQA , DOH) + Knowledge of quality improvement including HEDIS, STAR, CAHPS ... measures is preferred. + Familiarity with quality improvement and population health strategies + Curiosity to foster innovation and pave the way for growth + Humility to play as a team + Commitment to being the difference for our customers in every interaction… more
- Whitney Young Health Center (Albany, NY)
- …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 Joint ... Commission and Whitney M. Young Jr. Health Center. + Completes other duties as assigned. Requirements MINIMUM QUALIFICATIONS: Graduate from an accredited LPN program and has a current New York State LPN license. Five (5)+ years' nursing experience; Two (2)+… more