- Evolent (Austin, TX)
- …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
- CVS Health (Austin, TX)
- …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
- 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)
- …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 (Austin, TX)
- …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 (Austin, TX)
- …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
- Molina Healthcare (TX)
- …and processes are compliant with CMS and National Committee of Quality Assurance ( NCQA ) guidelines and Molina policies and procedures. + Participates in the daily ... workload of the department, performing Technician and/or Representative duties as needed. + Interviews with potential technician and service representative job applicants and provides hiring recommendations to Manager or Director. + Provides coaching for the… more
- Houston Methodist (Houston, TX)
- …position also performs general administrative duties in accordance with CLIA, HIPAA, NCQA and government standards, as well as company policies and procedures. The ... MA position participates in patient care which is under the direction of a physician and within the scope of a medical assistant. This position may also be required to schedule patient appointments, ensure medical necessity compliance, and verify eligibility… more
- Molina Healthcare (Dallas, TX)
- …and experience **PREFERRED EXPERIENCE:** * Knowledge of, and familiarity with, NCQA , CMS, and State regulatory submission requirements * Experience working in ... a cross-functional, highly matrixed organization * SQL proficiency * Knowledge of healthcare claim elements: CPT, CPTII, LOINC, SNOMED, HCPS, NDC, CVX, NPIs, TINs, etc. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** PMP, Six Sigma Green Belt, Six Sigma… more
- Sharecare (Austin, TX)
- …+ 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