- 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
- 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 (Santa Fe, NM)
- …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
- 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
- Molina Healthcare (Kenosha, WI)
- …for review. + Assures that activities and processes are compliant with NCQA guidelines and Molina policies and procedures and promotes best practice measures ... Quality Management and Health Education programs including, but not limited to, NCQA Accreditation, HEDIS, and Disease Management programs company wide. + Attends… more
- Centene Corporation (Salem, OR)
- …monitor and evaluate the performance of national delegated vendors according to CMS, NCQA , Federal and State requirements. **(This is a remote position. 30 hours per ... internal and external vendors against CMS, contractual, Federal, State, and NCQA standards + Review vendors documented processes against contractual, Federal, State,… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to assess team and individual metrics and in compliance with required reporting for NCQA , CMS and other stakeholders as needed. + Evaluate, plan and mange staffing ... to maintain all regulatory requirements including, but not limited to, NCQA , MCRA, CMS for turnaround times, documentation, notifications and audit activities.… more
- Centene Corporation (Phoenix, AZ)
- …Reviews outcomes in accordance with National Committee for Quality Assurance ( NCQA ) standards. Works with senior management to identify and implement opportunities ... on denial determinations in accordance with National Committee for Quality Assurance ( NCQA ) standards + Audits and revises correspondence letters to ensure they are… more
- Sharp HealthCare (San Diego, CA)
- …collaboration necessary for the continuum of care foundation for our NCQA required population health management program. Additionally, this position provides the ... clinical teams. + Assists CMO in the implementation of NCQA top decile improvement programs and work plans. +...committees, and the SHP Chief Medical Officer. + Supports NCQA survey activities. Prepares for site visits and responds… more
- Elevance Health (Atlanta, GA)
- …of health care management to direct the clinical quality initiatives, including NCQA accreditation and compliance with regulatory agencies and other objectives. The ... training and continuing education of staff regarding standards and guidelines, including NCQA and HEDIS. + Hires, trains, coaches, counsels, and evaluates the… more
- Molina Healthcare (TX)
- …+ Assists as needed in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation. + Provides ... review and abstraction + Intermediate knowledge of HEDIS and NCQA **PR** **E** **FE** **R** **RED E** **X** **PE**...managed care experience. + Advanced knowledge of HEDIS and NCQA . **PR** **E** **FE** **R** **RED L** **I** **C**… more
- UPMC (Media, PA)
- …performing functions related to quality management and improvement in compliance with NCQA , HEDIS, URAC, and the Commonwealth of Pennsylvania Department of Health ... and grievance for further action. + Responsible for assisting with preparation for NCQA , URAC, and other site visits. + Responsible for participating in updating the… more
- Centene Corporation (Salem, OR)
- …ensuring that all appeal letters generated comply with both State and NCQA requirements. **(PST preferred).** + Review clinical information for all appeals utilizing ... appeals and ensure letters are compliant with State and NCQA standards. + Maintain files and logs for all...determinations or clinical rationale + Maintain current knowledge of NCQA and State regulations + Coordinate Fair Hearings with… more
- 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
- Humana (Sterling Heights, MI)
- …all Contract, State, and federal requirements. The individual in this role supports NCQA accreditation and serves as the local health plan lead for accreditation ... the QAPI Program, and the annual QAPI work plan. + Operates an NCQA compliant quality program. + Oversee the development, implementation, and management of quality… more