- CareFirst (Baltimore, MD)
- …Health Equity accreditation. Enhance program performance in preparation for NCQA submission. Guides stakeholders through key decisions, communicates and coordinates ... requirements. Supports the organization's understanding and compliance with current NCQA standards. **_Note: We are looking for an experienced professional… more
- The Boeing Company (Mesa, AZ)
- …& Security** (BDS) is seeking a **Numerical Control Quality Engineer - NCQA (Associate, Experienced 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… more
- Humana (Frankfort, KY)
- …Senior Compliance Nurse Responsibilities:** + **Internal Audits and Monitoring:** Conduct NCQA audits per assignment (including stretch assignments/ad hoc audits) to ... and analysis of cases to assess outcome and metrics of market compliance with NCQA must pass UM elements. + **Audit Calibration:** Verify findings to maintain data… more
- Centene Corporation (Carson City, NV)
- …from inception to closure including National Committee for Quality Assurance ( NCQA ) and Healthcare Effectiveness Data and Information Set (HEDIS) preparation. **_ ... **Essential Responsibilities:** + Provide functional and technical knowledge for NCQA /HEDIS across all plan departmental staff and deliver educational sessions… more
- Elevance Health (Columbus, OH)
- …and Quality leads to direct the clinical quality initiatives, including NCQA accreditation and compliance with regulatory agencies and other objectives. **How ... within the company and to prioritize departmental projects, including maintaining NCQA , URAC and other accreditation compliance, according to Carelon corporate,… more
- Molina Healthcare (Long Beach, CA)
- …Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the ... LVN's with at least 4 years of UM experience, NCQA accreditation, and knowledge of InterQual / MCG guidelines....annual assessments as necessary to comply with state, federal, NCQA , and any other applicable requirements. + Distributes audit… more
- Humana (Frankfort, KY)
- …Humana. **Role Responsibilities:** + Serves as subject matter expert on NCQA Health Plan Accreditation UM requirements, advising stakeholders on compliance, and ... facilitating NCQA UM survey activities. + Works closely with operational...areas to prepare documentation and files for presentation to NCQA . + Advises operational leaders and frontline associates in… more
- Albany Medical Center (Albany, NY)
- …working independently on a closing the caseload for providers and assists with the NCQA payor and delegation audits and routine monitoring on an ongoing and annual ... basis. This position will assist with NCQA and Payor QA audits and the communication to...onboarding and training of new credentialing associates to the NCQA and provider enrollment process + Expertise with … more
- University of Florida (Jacksonville, FL)
- …and experience. Job Description: + Develops and coordinates patient services to review NCQA standards. + Assists and support the Quality Officer to review and ... members of the patient's treatment team. Maintains all records and reports related to NCQA /PCMH and keeps track of data in an Excel spreadsheet. + Coordinates PCMH… more
- Molina Healthcare (Albany, NY)
- …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
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