- Evolent (Austin, TX)
- …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 (Austin, TX)
- …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
- Molina Healthcare (Dallas, TX)
- …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
- CVS Health (Austin, TX)
- …the CAS and NLX applications remain in sync, supporting compliance and NCQA requirements. + Triage, submit in Greenfield, and monitor application incidents reported ... by the prior authorization Operations teams for Pharmacy (CAS) and Medical (NLX) clients. + **Available for on-call rotating schedule** to monitor, triage and submit urgent or escalated issues during evening and weekend hours. + Work with the Business and IT… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …Regulations and other accrediting and regulatory agencies such as the Joint Commission, NCQA and DNV + Coordinates in the credentialing process for the medical ... staff, allied health professionals and temporary privileges + Enters accurate and up to date data of new providers into the credentialing database to include but not limited to demographic and personal information, education/training, licensure, DEA, liability… more
- Highmark Health (Austin, TX)
- …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
- Evolent (Austin, TX)
- …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
- Apex Health Solutions (Houston, TX)
- …knowledge of ACO initiatives and care management processes Understanding of NCQA and CMS care management guidelines preferred Experience working in interdisciplinary ... teams Computer proficiency required Strong oral and written communication skills required Effective oral and written communication skill Some travel in the Houston metro area may be required Remote deployment will be considered SKILLS Knowledge of healthcare… more
- CVS Health (Austin, TX)
- …quantitative and qualitative data analysis to strategize and achieve operational targets for NCQA HEDIS and Medicare Stars * Provide analysis support for PIP reports ... to regulators, including statistical analysis of interventions and measure of impact of activities on performance **Required Qualifications** * At least 5 years experience in managed care, hospital, or similar healthcare environment * Must have statistical… more
- Molina Healthcare (Austin, TX)
- …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