- CareFirst (Baltimore, MD)
- …that include oversight of Health Plan and Health Equity accreditation. Enhance program performance in preparation for NCQA submission. Guides stakeholders ... requirements. Supports the organization's understanding and compliance with current NCQA standards. **_We are looking for an experienced professional...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- Cedars-Sinai (Los Angeles, CA)
- …people throughout Los Angeles and beyond. **Req ID** : 10223 **Working Title** : Program Manager - Managed Care ( Hybrid ) **Department** : MNS Managed ... **Job Description** The Program Manager is responsible for supporting...Familiarity with regulatory standards including but not limited to: NCQA , ICE, DMHC, DHCS, CMS and contracted health plans.… more
- CareFirst (Baltimore, MD)
- …of business and enrollees. Provides management and assessment of overall care management program for Medicaid enrollees from birth until age 65 when they transition ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...+ Solid understanding for COMAR regulations and knowledge of NCQA . **Knowledge, Skills and Abilities (KSAs)** + Ability to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …transform healthcare? Bring your true colors to blue. The Role:The Medical Clinical Program Manager will focus on utilization management compliance and audit ... Team: As an integral part of HMM Quality and Compliance team, the Clinical Program Manager works through the influence as an individual contributor while… more
- Sharp HealthCare (San Diego, CA)
- …cohesive collaboration necessary for the continuum of care foundation for our NCQA required population health management program . Additionally, this position ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...+ Plans, organizes, and directs the professional medical services program , consisting of all primary and specialty services for… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …us transform healthcare? Bring your true colors to blue. The RoleThe Sr. Program Manager , Clinical Quality is responsible for developing, managing, coordinating, ... may also coordinate accreditation activities on behalf of the organization. The Sr. Program Manager , Clinical Quality works closely and collaboratively with all… more
- Sharp HealthCare (San Diego, CA)
- …for implementing the Utilization/Cost Management Program and Quality Improvement Program , in conjunction with the Manager Medical Management and Quality ... care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief...plan Chief Medical Officer) in short and long range program planning, total quality management (quality improvement), and external… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …healthcare? Bring your true colors to blue. The Pharmacy Operations Clinical Pharmacist Manager manages and directs clinical staff in the day to day clinical ... in accordance with UM guidelines and are compliant with NCQA and CMS guidelines. In this role, you will...of Commercial and Medicare Part D formulary and clinical program offerings. + Contribute to a culture of service… more
- Humana (Madison, WI)
- …and help us put health first** Humana is seeking a Provider Contracting Manager to join the Wisconsin Medicaid Market (iCare) team. The Provider Contracting ... Manager will oversee a talented group of Provider Contracting...the iCare Provider Network to meet CMS, DHS, and NCQA standards. + Traveling throughout Wisconsin for provider meetings… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... support the safety net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the centralized… more
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