- CareFirst (Baltimore, MD)
- …Health Equity accreditation. Enhance program performance in preparation for NCQA submission. Guides stakeholders through key decisions, communicates and coordinates ... regulatory requirements. Supports the organization's understanding and compliance with current NCQA standards. **_We are looking for an experienced professional in… more
- The Boeing Company (Mesa, AZ)
- …Space & Security** (BDS) is seeking a **Numerical Control Quality Engineer - NCQA (Mid-Level or Senior)** to support the **Air Dominance Proprietary** team in ... **Mesa, Arizona** . **This position may be located on either 1st or 2nd shift and follows a 9/80 working schedule.** **This is at the hiring team's discretion and could potentially change in the future depending on the business needs.** This position will be… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and Medical Management's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. This position ... risks to closure, and collaboratively develop mitigation strategies. Other NCQA accreditation work includes delegation oversight and preparing documentation for… more
- Molina Healthcare (Oakland, CA)
- …Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA , CMS and State Medicaid requirements including delegation standards and ... that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the… more
- Molina Healthcare (FL)
- …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
- Humana (Louisville, KY)
- …draft detailed SAFe stories with success criteria to modify data feeds as NCQA rulesets change. **** **Data & Technical Leadership and influence:** + Work closely ... logic. + Stay up to date with evolving CMS, NCQA , and HEDIS requirements. + Ensure the data processing...**HEDIS measurement** + Familiarity with **CMS Stars programs** , NCQA standards, and quality performance metrics. + Experience working… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …program design and quality improvement initiatives as a consultant for NCQA accreditation standards (including monitoring for identification of risks and improvement ... The role serves as a resource regarding accreditation standards including NCQA standards and continuous quality improvement principles.This role also drives… more
- Centene Corporation (Olympia, WA)
- …initiatives at both the corporate and individual health plan levels according to NCQA , URAC and State requirements. + Work with Director of Accreditation to assist ... with Plan compliance to NCQA /URAC standards. + Maintain Quality Improvement policies and procedures in compliance with NCQA /URAC requirements and recommend… more
- Molina Healthcare (UT)
- …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
- Commonwealth Care Alliance (Boston, MA)
- …operations and compliance of the Appeals and Grievances department through many NCQA and other related quality program activities including: monthly case quality ... and training and areas on noncompliance. In addition to NCQA program support, this role will also support compliance...Peer calls between requesting MDs and CCA MDs, per NCQA requirements. + Coordinate BOH hearings with external State… more