- 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
- Commonwealth Care Alliance (Boston, MA)
- …complexities that require intensive care management and care delivery. Within the CIC Program , the Manager , Clinical APC is responsible for the oversight of ... and complex care management within the CIC interdisciplinary team. The Manager , Clinical APC is specifically accountable for assigned Advanced Practice Clinicians… 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
- Fallon Health (Worcester, MA)
- …provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for the Elderly)- in the region. ... process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements and member expectations. The FH… 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
- Fallon Health (Worcester, MA)
- …provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for the Elderly)- in the region. ... implement long term solutions to problems identified. + Escalate conflicts to Manager of Provider Relations and when appropriate Director, Provider Relations. +… more
- LA Care Health Plan (Los Angeles, CA)
- …Managed Risk Medical Insurance Board (MRMIB), National Committee for Quality Assurance ( NCQA ) and other rules/ regulations/ standards. The Manager is responsible ... Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los… more
- AmeriHealth Caritas (Newark, DE)
- …point of contact and be an advocate for members in the care coordination program . In addition, the Care Manager /Coordinator will oversee these same care ... The Maternal Care Manager (Registered Nurse /Social Worker) assists maternity members...the ACDE delivers high-quality care management services per Plan, NCQA , Federal/State standards and requirements. **Work Arrangement:** + Remote… 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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