- Cleveland Clinic (Cleveland, 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)
- …Experience with value-based care, utilization management, or regulatory reporting (eg, HEDIS, NCQA , Milliman). **To comply with HIPAA security standards (45 CFR sec. ... 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available… more
- Cleveland Clinic (Canton, 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
- Molina Healthcare (OH)
- …role. + 3+ years managed care experience. + Advanced knowledge of HEDIS and NCQA . **PR** **E** **FE** **R** **RED L** **I** **C** **E** **N** **S** **E,** **C** ... **E** **R** **TI** **FI** **C** **A** **T** **I** **O** **N** **, AS** **S** **O** **C** **I** **A** **TI** **O** **N** **:** Active RN license for the State(s) of employment **PHY** **S** **I** **C** **AL DEM** **A** **N** **D** **S** **:** Working… more
- Evolent (Columbus, OH)
- …Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + Provides clinical rationale for standard and expedited ... appeals. + 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. + On a requested basis, may function as… 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
- Evolent (Columbus, OH)
- …providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. + Documents all ... communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in… more
- Evolent (Columbus, OH)
- …providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. + Documents all ... communication with medical office staff and/or treating provider. + Practices and maintains the principles of utilization management by adhering to policies and procedures. + Participates in on-going training programs to ensure quality performance in… 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)
- …Review Accreditation Commission (URAC) and National Committee for Quality Assurance ( NCQA ) guidelines. + 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 in research activities/questions related to the Utilization… more