- 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
- 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
- Apex Health Solutions (Houston, TX)
- …conduct frequent audits to ensure compliance with regulatory entities such as CMS, NCQA , URAC. Intervenes, as necessary, to resolve member or provider issues with ... network pharmacies to ensure members receive medications in a timely manner. Communicate, collaborate and cooperate with internal and external stakeholders. Adheres to all Compliance/Program Integrity requirements. Complies with HIPAA Regulations Ensures safe… more
- ManpowerGroup (Houston, TX)
- …requirements in accordance with the Compliance Program, and with HHSC, TDI, NCQA and Health Plan Senior Management. * Ensure ongoing compliance with federal ... and state regulations and provide guidance and tools to assist the Health Plan in developing an auditing and monitoring program. Develop comprehensive audit tools to objectively measure internal performance and performance of third parties (ie subcontractors)… more