- 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
- CVS Health (Springfield, IL)
- …quality improvement projects from inception to closure including quality withhold performance, NCQA accreditation and contract compliance. + Develop the annual ... Reside in Illinois Must hold a Clinical License** The Manager of Health Care Quality will support the functions...Management Accreditation team to maintain the plan's NCQA accreditation . + Support the coordination of… more
- The Cigna Group (Bloomfield, CT)
- … Support** + Define and consult on measurement strategies and tools to support NCQA accreditation and state regulatory requirements + Ensure data integrity and ... **Job Profile Summary:** The Business Analytics Sr. Manager oversees a team of analytics professionals focused on clinical quality measurement and insights. Works in… 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
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Case Manager 2 manages complex cases and is responsible for supporting the Case Management team and Health Services leadership in ensuring ... complex cases meet regulatory and accreditation requirements. May manage a high acuity caseload and serve as a preceptor for newly hired case managers. **ESSENTIAL… 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 (Req 100984) Albany, NY (http://maps.google.com/maps?q=920+Lark+Drive+Albany+NY+USA+12207) Apply Description Be a part of the… more
- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Case Manager , Medicaid Long Term Support Program ** to join #TeamMVP. If you ... care. + Compliance & Quality: Ensure adherence to Medicaid, Medicare, and accreditation standards (eg, NCQA ), including documentation and reporting. + Cost… more
- Fallon Health (Foxborough, 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
- 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
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …including 3+ years in Utilization Management leadership experience. + Experience with accreditation organizations (URAQ/ NCQA ) + Organized with the ability to ... About The Role The Manager , Utilization Management (UM) will manage the Utilization...for day-to-day operational escalations related to the Utilization Management program . + Establish and maintain positive intradepartmental and client… more
- CVS Health (Austin, TX)
- …with Medicare, Medicaid, and commercial insurance plans. + Familiarity with NCQA accreditation standards. **Education** Registered Nurse, BSN preferred ... with heart, each and every day. **Position Summary** The Manager of Prior Authorization oversees the daily operations of...for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed… more
- CVS Health (Phoenix, AZ)
- …+ 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
- Molina Healthcare (Las Vegas, NV)
- …* 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
- Fallon Health (Plymouth, 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