- Molina Healthcare (Savannah, GA)
- …management. **Job Duties** ** Program Oversight & Project Management** + Directs accreditation work plans and timelines to meet NCQA and contractual ... department or cross-functional teams of subject matter experts, delivering on NCQA accreditation requirements. Plans and directs schedules, reporting, process… more
- CareFirst (Baltimore, MD)
- …include oversight of Health Plan and Health Equity accreditation . Enhance program performance in preparation for NCQA submission. Guides stakeholders through ... with internal and external stakeholders to launch, maintain, and enhance NCQA accreditation strategies and interventions. Provides direction and motivation… more
- Columbia Memorial Hospital (Astoria, OR)
- …Professional in Healthcare Quality (CPHQ). Preferred: Credential(s) from the Healthcare Accreditation Certification Program (s) (HACP). Preferred: Three (3) years ... ELIGIBLE FOR CMH EMPLOYEE REFERRAL BONUS: NON-PRIORITY RECRUITMENT The Accreditation , Regulatory, and Licensing Nurse Specialist ensures compliance with licensing, … 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 ... risks to closure, and collaboratively develop mitigation strategies. Other NCQA accreditation work includes delegation oversight and...part of HMM Quality and Compliance team, the Clinical Program Manager works through the influence as… more
- OhioHealth (Columbus, OH)
- …and in our communities. **Job Description Summary:** The Central Verifications Office Credentialing Program Manager (CVO PM) reports to the Director of CVO & ... the CVO to support TJC accreditation for the OhioHealth hospitals and NCQA accreditation to support the CIN and OhioHealthy Medical Plan. The CVO PM is… more
- Highmark Health (Camp Hill, PA)
- …(FEP) Quality Program , (b) the National Committee for Quality Assurance ( NCQA ), (c) Joint Commission accreditation compliance, (d) quality measures required ... Quality Program , (b) the National Committee for Quality Assurance ( NCQA ) compliance, (c) Joint Commission accreditation compliance, (d) quality measures… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …Federal Employee Program (FEP) and National Committee for Quality Assurance ( NCQA ) accreditation standards, as appropriate to the member's case assignment. ... Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities, and performs the… more
- CVS Health (Lansing, MI)
- …/ Medicaid experience -Experience with HEDIS Metrics, CAHPS Member Satisfaction Surveys, NCQA Accreditation , Compliance Audits and/or MI State Reporting / ... Summary** Supportive of State of Michigan Quality Contract deliverables, QAPI Program and regulatory standards. Processes and evaluates complex data and information… more
- Whitney Young Health Center (Albany, NY)
- …regulation (FQHC), ie DHHS HRSA, CMS guidelines, and NYSDOH (article 28), and all accreditation standards (eg Joint Commission and NCQA -PCMH). + Adheres to the ... Registered Nurse (RN) Care Manager - Women's Health/Pediatrics Albany, NY (http://maps.google.com/maps?q=920+Lark+Drive+Albany+NY+USA+12207) Apply Description Be a… 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. ... follow us on Facebook, Twitter and LinkedIn. **Brief Summary of Purpose:** The Manager , Prior Authorization RN manages all staffing and activities related to prior… more
- WellSense (Manchester, NH)
- …implementation of policies and procedures that integrate state, federal and national accreditation regulations to ensure compliance. The manager will oversee the ... Manager of Care Management WellSense Health Plan is...consistent with current federal and state regulations and applicable accreditation standards (eg NCQA ) + Works closely… more
- WellSense (Manchester, NH)
- …and in keeping with contractual requirements, internal policy and NCQA accreditation standards.Facilitates multidisciplinary consultation on members' behalf ... Clinical Care Manager WellSense Health Plan is a nonprofit health...or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly… more
- Commonwealth Care Alliance (Boston, MA)
- …development experience + Value-based contracting familiarity + Education/Training experience + NCQA Accreditation Experience + Healthcare Quality Measures EEO is ... that require intensive care management and care delivery. Within the CIC Program , the Manager , Clinical APC is responsible for the oversight of clinical care… more
- CVS Health (Little Rock, AR)
- …+ Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (eg, NCQA , URAC, state and federal standards and ... that promote high-quality healthcare for members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This… more
- CVS Health (Little Rock, AR)
- …+ Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (eg, NCQA , URAC, state and federal standards and ... that promote high-quality healthcare for members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This… 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
- CVS Health (Richmond, VA)
- …management, case management, disease management. + Experience with URAC and NCQA accreditation requirements + Experience collaborating with legal counsel ... + Supports the implementation and maintenance of an effective Compliance program supporting First Health, Aetna Signature Administrators, and American Health… more
- Sharp HealthCare (San Diego, CA)
- …**What You Will Do** Manage an effective in-patient Care Management program that includes initial and concurrent review; case management/discharge planning ... plans related to health plan audits and requirements of NCQA . Collaborates with the Quality, Compliance and Training Department...and implements new programs under the direction of the manager of in-patient care management and the Director of… more
- Somatus (Mclean, VA)
- …strategy in a fast-paced, evolving environment + Familiarity with CMS programs and NCQA accreditation survey experience, including submission of documents to ... responsible for establishing, implementing, and overseeing an effective quality improvement program essential to meet NCQA requirements, state specific… 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