- Highmark Health (Columbus, OH)
- …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
- CVS Health (Columbus, OH)
- …policy development, and corrective action planning. **Preferred Qualifications** + NCQA credentialing experience. + Familiarity with tools such as QuickBase, ... Excel, and provider data platforms. + Project management experience. + Strong analytical and data-driven decision-making skills. + Ability to influence and collaborate across all levels of the organization. **Education** + Bachelors degree preferred or a… more
- Molina Healthcare (Akron, OH)
- …performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **Job ... Duties** + The Mgr, Clinical Data Acquisition uses knowledge, skills and technical expertise to manage the mission critical nature of the performance measurement data collection, reporting and monitoring process, including HEDIS, state-based measure reporting… more
- CVS Health (Columbus, OH)
- …processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, ... while adhering to company policy and procedures. + Manage population health member enrollment for child and family welfare. Development of Wellness Plan, providing community resources, reviewing gaps in care, administering health questionnaires, and other… more
- Cleveland Clinic (Mayfield Heights, OH)
- …states Licensing Board. + Current DEA License or DEA designee as required by NCQA . + Basic Life Support (BLS) through the American Heart Association (AHA) required. ... + Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) through the American Heart Association (AHA); or Neonatal Resuscitation Program (NRP) through the American Academy of Pediatrics (AAP); or Advanced Trauma Life Support (ATLS)… more
- Cleveland Clinic (Mayfield Heights, OH)
- …states Licensing Board. + Current DEA License or DEA designee as required by NCQA . + Basic Life Support (BLS) through the American Heart Association (AHA) required. ... + Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) through the American Heart Association (AHA); or Neonatal Resuscitation Program (NRP) through the American Academy of Pediatrics (AAP); or Advanced Trauma Life Support (ATLS)… more
- Evolent (Columbus, OH)
- …Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + Aids and acts as a resource to Initial Clinical ... Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
- Molina Healthcare (Cleveland, OH)
- …4-years' experience in Credentialing. * Required knowledge of Medicaid, CMS, NCQA and other credentialing regulations. * Experience leading employees, preferably in ... a production-related role. * Demonstrated adaptability and flexibility to changes and response to new ideas and approaches. * Strong problem-solving skills including root cause analysis and prompt resolution. * Excellent interpersonal and communication skills… more
- Evolent (Columbus, OH)
- …Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + Aids and acts as a resource to Initial Clinical ... Reviewers. + 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… more
- Highmark Health (Columbus, OH)
- …and privileging requirements of the Department of Health, Joint Commission, NCQA , URAC and other governmental requirements, and performs in accordance with ... these standards. Generates and maintains accurate documentation that may be reviewed and judged for acceptability by state and federal licensing agencies. Handles customer questions and complaints. **ESSENTIAL RESPONSIBILITIES** + Reviews medical staff and… more