- Molina Healthcare (Tacoma, WA)
- …adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA -compliant ... and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. + Reviews quality referred issues, focused… more
- Molina Healthcare (WA)
- …and state delegated activities, ensuring compliance with State, Federal, NCQA and Molina delegation standards and requirements. Provides delegation oversight ... delegation audit assessment tools as necessary to comply with state, federal, NCQA , and any other applicable requirements. + Assists with chairing monthly meetings… more
- Humana (Olympia, WA)
- …within Humana. **Role Responsibilities:** + Serves as subject matter expert on NCQA Health Plan Accreditation Member Experience (ME) and Medicaid Module (MED) ... areas to prepare documentation and files for presentation to NCQA . + Advises operational leaders and frontline associates in...or BSN degree. + 3+ years of experience in NCQA Health Plan Accreditation and/or Medicaid Module. + Exceptional… more
- Molina Healthcare (Spokane, WA)
- …+ Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation. + Provides ... review and abstraction + Intermediate knowledge of HEDIS and NCQA **PR** **E** **FE** **R** **RED E** **X** **PE**...managed care experience. + Advanced knowledge of HEDIS and NCQA . **PR** **E** **FE** **R** **RED L** **I** **C**… more
- Molina Healthcare (Everett, WA)
- …measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. ... provides the strategic direction and implementation of corporate and/or Molina plan NCQA accreditation surveys and federal and state QI Compliance activities. +… more
- Molina Healthcare (Bellevue, WA)
- …and documents delegation assessments as necessary to comply with state, federal, NCQA , and any other applicable requirements. + Prepares status reports from ... Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team. **JOB… more
- Highmark Health (Olympia, WA)
- …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 (Olympia, WA)
- …Certified Professional in Healthcare Quality (CPHQ) or equivalent + Certified NCQA PCMH Content Expert **Education/license requirements:** + Bachelor's degree or ... commensurate work experience in healthcare administration, public health, or a related field **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $54,300.00 - $159,120.00 This pay range represents the… more
- Molina Healthcare (Vancouver, WA)
- …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 (Olympia, WA)
- …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