- Sharp HealthCare (San Diego, CA)
- …corrective action plans related to health plan audits and requirements of NCQA . Collaborates with the Quality, Compliance and Training Department to effectively ... integrate and implement process consistent with Health Plan requirements, NCQA , legislation and CMS. Develops and implements new programs under the direction of the… more
- Highmark Health (Harrisburg, PA)
- …other quality and regulatory requirements including, but not limited to, NCQA , DOH, and additional state-specific mandates. **ESSENTIAL RESPONSIBILITIES** + Performs ... Ensures adherence to all regulatory and compliance guidelines (CMS, NCQA , DOH, etc.) as it pertains to the pharmacy...Plan. + Experience with regulatory entities such as CMS, NCQA , HEDIS, DOH etc. **Preferred** + None **LICENSES or… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …consistently, timely and accurately in accordance with UM guidelines and are compliant with NCQA and CMS guidelines. In this role, you will manage a clinical staff ... to ensure regulatory compliance with CMS Chapter 18, and NCQA guidelines + Provide clinical support to internal partners...service and operational programs is desirable. + Knowledge of NCQA and CMS Regulatory guidelines is desirable + Experience… more
- Molina Healthcare (Las Vegas, NV)
- …activities to maintain compliance with state requirements and federal and/or NCQA quality requirements, as appropriate in collaboration with quality leadership. ... activities to maintain compliance with state requirements and federal and/or NCQA quality requirements, as appropriate in collaboration with quality leadership with… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Federal Employee Program (FEP) and National Committee for Quality Assurance ( NCQA ) accreditation standards, as appropriate to the member's case assignment. Uses ... of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the...requirements are being met, such as NYS DOH, CMS, NCQA , and HEDIS, serving as internal auditor within the… more
- University of Washington (Seattle, WA)
- …medical staff bylaws, institutional policy, and complex external standards (eg, TJC, NCQA , CMS, URAC, DOH) that govern clinicians and hospital operations. Operating ... regulatory findings. + Translate regulatory standards and accreditation requirements (TJC, NCQA , CMS, URAC, DOH) into clear, actionable policies and operational… more
- Corewell Health (Grand Rapids, MI)
- …business process improvements. Essential Functions + Ensure compliance with NCQA standards and guidelines, driving continuous improvement in accreditation efforts ... team leadership. Preferred + Experience with all facets of NCQA accreditations + Knowledge of NCQA accreditation...facets of NCQA accreditations + Knowledge of NCQA accreditation processes and standards + Planning, project management… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …Kelsey-Seybold has been recognized by the National Committee for Quality Assurance ( NCQA ) as the nation's first accredited Accountable Care Organization and a Level ... area certified for excellence in diabetes and heart and stroke care by the NCQA . In addition to these recognitions, Kelsey-Seybold is home to a nationally accredited… more
- Centene Corporation (Montgomery, AL)
- …provider practice sites regarding the National Committee for Quality Assurance ( NCQA ) HEDIS measures and risk adjustment. Provides education for HEDIS measures, ... and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements. + Collects, summarizes, trends, and delivers provider quality and risk… more
- Kelsey-Seybold Clinic (Houston, TX)
- …Kelsey-Seybold has been recognized by the National Committee for Quality Assurance ( NCQA ) as the nation's first accredited Accountable Care Organization and a Level ... area certified for excellence in diabetes and heart and stroke care by the NCQA . In addition to these recognitions, Kelsey-Seybold is home to a nationally accredited… more
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