- Humana (Columbus, OH)
- …Humana. **Role Responsibilities:** + Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and ... facilitating NCQA UM survey activities. + Works closely with operational...areas to prepare documentation and files for presentation to NCQA . + Advises operational leaders and frontline associates in… more
- Molina Healthcare (Akron, OH)
- …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
- OhioHealth (Columbus, OH)
- …for continued accreditation by the National Committee for Quality Assurance ( NCQA ) and other regulatory organizations (if applicable). Manages the ongoing ... development, oversight, and implementation of NCQA policies and procedures that guide and support the provision of services, as well as compliance with all… more
- Medical Mutual of Ohio (OH)
- …To include data documentation, compilation, reconciliation, and research.Works directly external HEDIS/ NCQA auditor to resolve any items on Issue Log. + Reviews ... claims, pharmacy, encounter, and quality measurement data. + Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems. + Advanced… more
- Molina Healthcare (Cleveland, OH)
- …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
- Highmark Health (Columbus, OH)
- …coordinates and maintains delegated credentialing program in accordance with GHP, NCQA , and all regulatory agency standards. This includes delegation program, ... oversight of credentialing delegates to ensure that the delegated entities meet all NCQA , DPW, and DOH, policies and procedures related to GHP's delegated program. +… more
- OhioHealth (Columbus, OH)
- …both The Joint Commission (TJC) and National Committee for Quality Assurance ( NCQA ) policies and procedures. **Responsibilities And Duties:** 90% The CVO PM manages ... managed by the CVO to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan. The CVO PM is… more
- Molina Healthcare (Columbus, OH)
- …+ 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 (Toledo, OH)
- …health plan state provider agreement, National Committee for Quality Assurance ( NCQA ), Centers for Medicare and Medicaid Services (CMS), policies and procedures, ... * Assists in preparation of documents for utilization management, care management, state, CMS, NCQA and other regulatory audits as needed. * Local travel of up to… more
- Molina Healthcare (Dayton, OH)
- …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