- 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
- 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 (Boston, MA)
- … program design and quality improvement initiatives as a consult for NCQA accreditation standards (including monitoring for identification of risks and ... improvement opportunities). The role serves as a resource regarding accreditation standards including NCQA standards and continuous... activities on behalf of the organization The Sr. Program Manager , Clinical Quality works closely and… more
- Excellus BlueCross BlueShield (Rochester, 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
- Beth Israel Lahey Health (Charlestown, MA)
- …health system to attract, retain and develop diverse talent. The Health Equity Program Manager will contribute to achieving this vision through partnership with ... outcomes for BIPOC, LGBTQIA+ and other underrepresented communities. The Health Equity Program Manager plays a leadership role in establishing strategic… 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 (Req 100987) Albany, NY...to review at risk population with providers to prioritize program enrollment, care planning, addressing prognosis and potential palliative/hospice… more
- Fallon Health (Lowell, MA)
- …provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE ( Program of All-Inclusive Care for the Elderly)- in the region. ... and LinkedIn. **Brief summary of purpose:** The Nurse Case Manager (NCM) is an integral part on an interdisciplinary...for MassHealth programs such as the personal care attendant program , adult foster care, group adult foster care, and… 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
- Baylor Scott & White Health (Temple, TX)
- …reports, metrics, and documentation on utilization performance indicators and NCQA accreditation and compliance requirements. Consults with physicians ... larger, more complex organization or functional area than a manager . Has multiple managers reporting to the role. ESSENTIAL...of managed care concepts. 6. Knowledge and experience managing NCQA accreditation standards. 7. Ability to work… 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 (UT)
- …+ 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 (Workman, MN)
- …+ Implement clinical policies & procedures in accordance with applicable regulatory and accreditation standards (eg, NCQA , URAC, state & federal standards & ... all with heart, each and every day. **Position Summary** The **Associate Manager , Clinical Health Services (Prior Authorization)** is responsible for oversight of… 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
- CareFirst (Baltimore, MD)
- …action-oriented and time-specific to stabilize the health care condition and meet NCQA standards of documentation for Care Management Accreditation . + ... and Director of Care Management for the Federal employee program . They are to ensure available resources are being...Health Worker. The role works closely with the Care Manager , Supervisor or Manager to develop and… 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
- Molina Healthcare (San Bernardino, CA)
- …* Participates in preparation for national committee for quality assurance ( NCQA ) and utilization review accreditation commission (URAC) certifications. * ... services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality… 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
- College of American Pathologists (Washington, DC)
- …organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists ... roadmaps for the Pathology Quality R egistry with support of CAP Enterprise Program staff; identify areas of opportunity to increase the value of registries through… 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. ... delivery of items as part of the 'Oh Baby' program and work with Nurse Case Managers to coordinate...needs + The Navigator refers to the Nurse Case Manager /PCP whenever clinical decision making is required. **Responsibilities** **Note:… more