The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member.
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The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member.
The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member.
The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member.
VP Quality Health Plan
Albuquerque, NM · On-site +1
Responsible for the annual HEDIS submission, PHP Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance. * Directs the activities for Performance Improvement ...
VP Quality Health Plan
Albuquerque, NM · On-site +1
Responsible for the annual HEDIS submission, PHP Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance. * Directs the activities for Performance Improvement ...
Responsible for the annual HEDIS submission, PHP Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance. * Directs the activities for Performance Improvement ...
Responsible for the annual HEDIS submission, PHP Medicare Star Program Ratings, NCQA accreditation, and regulatory and contractual compliance. * Directs the activities for Performance Improvement ...
Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure ...
Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure ...
Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure ...
Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure ...
Supervisor Appeals
Philadelphia, PA · On-site
$22.25 - $27.50/hr
Educates staff on new or updated procedures, NCQA and state rule changes, and internal process improvements; monitors adoption of procedures to ensure consistency and accuracy. * Coaches, develops ...
Supervisor Appeals
Philadelphia, PA · On-site
$22.25 - $27.50/hr
Educates staff on new or updated procedures, NCQA and state rule changes, and internal process improvements; monitors adoption of procedures to ensure consistency and accuracy. * Coaches, develops ...
Ensure timely review, processing, and response to appeal in accordance with State, Federal, and NCQA standards. * Communicate with members, providers, facilities, and other departments regarding ...
Ensure timely review, processing, and response to appeal in accordance with State, Federal, and NCQA standards. * Communicate with members, providers, facilities, and other departments regarding ...
The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements.
The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements.
Interpret annual NCQA HEDIS technical specification changes and assess their impact on data, reporting, and production processes. * Support annual HEDIS production and Medical Record Review (MRR ...
Interpret annual NCQA HEDIS technical specification changes and assess their impact on data, reporting, and production processes. * Support annual HEDIS production and Medical Record Review (MRR ...
Credentialing Specialist
TX · On-site +1
Query appropriate organizations and evaluate responses to ensure provider compliance with NCQA standards. Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other ...
Credentialing Specialist
TX · On-site +1
Query appropriate organizations and evaluate responses to ensure provider compliance with NCQA standards. Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other ...
Credentialing Coordinator
Dallas, TX · On-site
The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements.
New
Credentialing Coordinator
Dallas, TX · On-site
The Specialist must ensure all credentialing functions comply with internal policies, client health plan contracts, URAC guidelines, NCQA standards, and applicable state and federal requirements.
New
Interpret annual NCQA HEDIS technical specification changes and assess their impact on data, reporting, and production processes. * Support annual HEDIS production and Medical Record Review (MRR ...
Interpret annual NCQA HEDIS technical specification changes and assess their impact on data, reporting, and production processes. * Support annual HEDIS production and Medical Record Review (MRR ...
Staff Readiness Manager
$85K - $100K/yr
Must have a working knowledge of accreditation and certification standards for JCAHO and NCQA, and applicable federal and state laws as they apply to the credentialing procedures for hospitals and ...
Staff Readiness Manager
$85K - $100K/yr
Must have a working knowledge of accreditation and certification standards for JCAHO and NCQA, and applicable federal and state laws as they apply to the credentialing procedures for hospitals and ...
Credentialing Specialist
Boca Raton, FL · On-site +1
Adhere to NCQA guidelines. * Audit Provider Licensure Files to NCQA guidelines. * Pull Monthly Delegated Verification Files in accordance with NCQA. * Knowledge of Delegated Verification Websites (ie.
Credentialing Specialist
Boca Raton, FL · On-site +1
Adhere to NCQA guidelines. * Audit Provider Licensure Files to NCQA guidelines. * Pull Monthly Delegated Verification Files in accordance with NCQA. * Knowledge of Delegated Verification Websites (ie.
McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and ...
McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA). MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and ...
The UM RN also supports quality gap closure, care coordination, quality improvement initiatives, NCQA accreditation requirements, and departmental performance goals, while maintaining established ...
The UM RN also supports quality gap closure, care coordination, quality improvement initiatives, NCQA accreditation requirements, and departmental performance goals, while maintaining established ...
Leads the cross organizational preparation for the NCQA accreditation survey project. * Responsible for completion and analysis of annual HEDIS/CAHPS results and works with all areas to integrate ...
Leads the cross organizational preparation for the NCQA accreditation survey project. * Responsible for completion and analysis of annual HEDIS/CAHPS results and works with all areas to integrate ...
CMS or NCQA-related compliance activities Experience developing, implementing, and monitoring corrective action plans (CAPs). Experience reviewing healthcare operational policies, procedures, and ...
CMS or NCQA-related compliance activities Experience developing, implementing, and monitoring corrective action plans (CAPs). Experience reviewing healthcare operational policies, procedures, and ...
Staff Readiness Manager
Albuquerque, NM · On-site
$85K - $100K/yr
Must have a working knowledge of accreditation and certification standards for JCAHO and NCQA, and applicable federal and state laws as they apply to the credentialing procedures for hospitals and ...
Staff Readiness Manager
Albuquerque, NM · On-site
$85K - $100K/yr
Must have a working knowledge of accreditation and certification standards for JCAHO and NCQA, and applicable federal and state laws as they apply to the credentialing procedures for hospitals and ...
Health Plan Accreditation Specialist
Flint, MI • On-site
McLaren Integrated HMO Group
Full-time
Posted 19 days ago
Job description
McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a National Committee for Quality Assurance Specialist to join in leading the organization forward.
MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. McLaren Health Plan is accredited by the National Committee for Quality Assurance (NCQA).
MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org
Position Summary:
The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member. The functions may include but are not limited to committee support; regulatory and accreditation standard adherence; delegation oversight; performance monitoring and assessment; data collection and analysis; and the continual advancement of the quality improvement process to achieve the Health Plan's goals of excellence.
Essential Functions and Responsibilities:
Accountable for assigned standards from National Committee for Quality Assurance (NCQA), which may involve oversight of delegated activities.
Works with Plan departments, such as Quality, Contracting, Provider Relations, Member Services, Appeals and Grievances, Pharmacy Services, Utilization and Medical Management, Credentialing, and other departments and delegates to ensure that NCQA standards are met, and appropriate documentation is maintained.
Counsels, guides and instructs Health Plan employees on adherence to accreditation standards, NCQA-focused activities and other quality improvement initiatives.
Supports the Plan committee functions and activities as assigned. Ensures that meetings are organized, well documented and that they meet the Plan goals and objectives and the individual Committee's roles and responsibilities.
Leads quality projects as directed, including appropriate audits and state projects and requirements.
Assumes project management as directed.
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Qualifications:
Required:
Associate degree in a health care field or equivalent work.
Four (4) years' experience with a government regulated health organization or a managed care setting with at least two (2) years' experience performing complex quality management activities including HEDIS, NCQA etc.
Preferred:
Bachelor's in healthcare or related field.
Experience writing quantitative and qualitative analysis.
Knowledge of the National Committee on Quality Assurance (NCQA) Standards for the accreditation of managed care organizations and HEDIS specifications; the managed care environment and the basic tenets of continuous quality improvement.
Additional Information
- Schedule: Full-time
- Requisition ID: 26002953
- Daily Work Times: 8:30 am - 5:00 pm
- Hours Per Pay Period: 80
- On Call: No
- Weekends: No