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$90k - $105k
Reporting to the Director, Regulatory Affairs, the NCQA Program Manager is an experienced healthcare professional who manages and leads activities associated with SFHP's NCQA Accreditation. These activities include ongoing monitoring and analysis of plan performance against...SuggestedWork experience placementWork at officeFlexible hours$90k - $105k
San Francisco Health Plan seeks an experienced NCQA Program Manager to manage NCQA accreditation processes. This role involves leading department communications, coordinating accreditation activities, and analyzing performance against NCQA standards. Candidates must possess...Suggested- ...policies and procedures are up to date and in compliance with all accrediting and regulatory bodies for the Medicaid Segment to include NCQA, URAC, CMS and AHCCCS. Works collaboratively with the broader AZ Blue accreditation and quality teams to support reaccreditation...SuggestedFull timeWork at officeRemote work2 days per week1 day per week
- Blue Cross Blue Shield of Arizona is hiring for a leadership role focused on the Medicaid Segment's accreditation processes. This position requires 10 years of experience in managed care and accreditation, as well as a Bachelor's degree in a health service related field...SuggestedFull time
- ...Credentialing Specialist to manage the credentialing process for healthcare providers. This role involves ensuring compliance with NCQA standards and maintaining accurate records essential for quality care. The ideal candidate will conduct background checks, collaborate...Suggested
- ...to oversee the compliance and quality initiatives within the plan. This role involves direct supervision of staff, compliance with NCQA standards, and implementation of quality improvement programs. The successful candidate will have a proven track record in quality management...Suggested
- Humana Inc is seeking a Risk Management Professional 2 to lead quality audits within CenterWell UM, ensuring CMS/NCQA compliance and regulatory readiness. The role emphasizes audit accuracy, data analysis, and identifying risks using Power BI and Power Apps. The ideal...Suggested
$68.04k - $118.8k
...agencies. Ensure that all Care Management processes and reporting are compliant with all applicable federal and state regulations, and NCQA and company standards. Participate in delegation collaboration activities, as required. Research evidence-based guidelines, medical...SuggestedFull timeFlexible hoursWeekend workAfternoon shift$38.1k - $80k
...the dental network. The role also conducts audits for credentialing and network data quality, understands credentialing policies per NCQA, URAC, and CMS standards, and serves as a liaison to delegated entities and vendors to ensure current credentialing processes are in...SuggestedWork at office$38.1k - $80k
...role also conducts audits for credentialing as well as network data quality. Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements. Serves as a liaison to delegated entities and vendors to ensure current and...SuggestedWork at office- IntelliResume is seeking a Clinical Quality Manager to oversee health plan quality improvement initiatives, focusing on HEDIS and NCQA performance. This fully remote role will require collaboration across clinical and operational teams to enhance member care. The ideal...SuggestedRemote job
$100k - $120k
...measures. Responsibilities include performing QA on measure charts, reviewing data compliance, and analyzing specifications according to NCQA guidelines. The ideal candidate should have a strong understanding of medical coding standards, excellent communication skills, and...Suggested- ...examinations. The LPN will work closely with interdisciplinary teams to ensure comprehensive care delivery in compliance with HIPAA and NCQA standards. Duties Conduct thorough patient assessments including vital signs, physical examinations, and physiological...Suggested
Rhonda's House
Youngstown, OH12 days ago - ...community wellness programs. About the position: Part-time 20 hours per week Total outpatient EPIC EMR Certified by NCQA as a level 3 Medical Home Model of Care Opportunity to teach medical students and residents from Boston University Spanish interpreter...SuggestedWork visa
Enterprise Medical Recruiting
Boston, MA5 days ago $20 per hour
...~Able to work independently and in a team setting ~Strong attention to detail and problem-solving skills ~Familiarity with NCQA, CMS, and state credentialing standards ~Excellent written, verbal, and interpersonal communication skills Requirements ~Verify...SuggestedFull timeTemporary workWork at officeRemote workFlexible hoursSagility
Remote8 days ago- ...Credentialing Specialist also ensures healthcare professionals and facilities meet all established federal and state standards, as well as NCQA (National Committee for Quality Assurance) standards. ~Completes review of provider credentialing and re-credentialing...Full timeWork at officeRemote work
DETROIT WAYNE Integrated HEALTH Network
Remote8 days ago $150k - $170k
...management systems Requirements ~Master's degree (MHA, MBA, MPH) or equivalent advanced experience (preferred) ~Experience with NCQA accreditation and HEDIS measure management in a delegated environment (preferred) ~Lean, Six Sigma, or equivalent process...Full timeBZ Health Management LLC
Remote1 day ago$23 - $26 per hour
...Ensure all credentialing processes are in compliance with company policies as well as the National Committee for Quality Assurance (NCQA) standards in an effort to maintain accreditation. ~Provides development and coaching to employees on a consistent basis. Feedback...Hourly payFull timeTemporary workFlexible hoursClaritev
Remote4 days ago$72k - $82k
...Maintain ongoing relationships with network providers. ~Address any concerns and ensure proper compliance with company policies, NCQA standards, and industry regulations. Qualifications ~Three (3) years’ experience preferred in provider relations. ~Experience...Temporary workWork experience placementRemote workWork from homeFlexible hoursBirdsong Hearing Benefits
Remote6 days ago$55k - $60k
...~Compliance & Quality Assurance: ~Monitor adherence to all relevant regulatory, payer, and accreditation requirements (e.g., NCQA, CMS, state licensing boards). ~Support audits, compliance reviews, and corrective action planning. ~Contribute to process improvement...Full timeRemote workWork from homeFlexible hoursCurai
Remote12 hours ago$188.27k - $288.05k
...responsibilities. You will lead and/or support the governance, validation, and monitoring of AI/LLM tools. You will additionally support URAC/NCQA-aligned quality operations across our virtual and hybrid care models. This role reports to the Patient Safety Officer within the...Full timeWork at officeRemote workWork from homeHome officeIncluded Health
Remote12 hours ago$100k - $120k
...to support onboarding volume and geographic expansion. ~Develop and maintain credentialing policies and procedures aligned with NCQA, CMS, and state-specific guidelines. ~Manage payer enrollment processes, including delegated credentialing arrangements, and support...Full timeRemote workHeadlight
Remote12 hours ago$60k - $68k
...in multi-state telehealth, digital health, or a high-growth healthcare environment. ~Exposure to credentialing standards (e.g., NCQA, CMS). Benefits ~Compensation: $60,000-$68,000 with opportunities for advancement. ~Equity. ~Professional development &...Full timeContract workTemporary workRemote workWork from homeFlexible hoursAllara
Remote4 days ago- ...information, and timing gaps. ~Maintain accurate and audit-ready records in credentialing software and shared drives in compliance with NCQA and internal standards. ~Understand all critical lifecycle milestones (application receipt, committee review, approvals,...Full timeWork at officeFlexible hours
Monogram Health
Remote1 day ago $174.07k - $374.92k
...Excellent verbal and written communication skills ~ A current, clinical, unrestricted license to practice medicine in the United States. (NCQA Standard) ~ Prior clinical leadership or supervision experience is preferred. ~ Graduate of an accredited medical school. M.D. or...Hourly payFull timeTemporary workLocal areaFlexible hoursOak Street Health
Illinois City, IL7 days ago- ...relationships with healthcare payer, provider, and care management stakeholders. ~Quality & Regulatory Compliance ~Ensure adherence to NCQA, CMS, HIPAA, URAC, and client-specific requirements. ~Support audit readiness and regulatory compliance activities. ~Monitor...Full timeWork from home
Sagility
Remote3 days ago $83.8k - $157.89k
...Requirements ~Master’s degree in Data Science, Public Health, Biostatistics, Healthcare Analytics, or related field. ~Experience with NCQA HEDIS measures and reporting processes. ~Familiarity with Medicare Stars, Medicaid quality programs, and value-based care models....Full timeFlexible hoursCapital Blue Cross
Remote1 day ago- ...Operations, Care Management, Engineering, Analytics, Coding, Payer Relations, and Executive Leadership. ~Translation of evolving NCQA and payer requirements into product capabilities before they become operational challenges. ~Executive reporting that clearly demonstrates...Full timeTemporary workFlexible hours
Matrix Medical Network
Remote4 days ago $115k - $133k
...healthcare data standards and coding systems (ICD-10, CPT, DRG) and familiarity with healthcare quality measures (e.g., HEDIS, CMS, NCQA), preferably within Medicare Advantage. You have the ability to validate data quality, identify anomalies, document analytical assumptions...Full timeWork at officeRemote workFlexible hoursClover Health
Remote7 days ago$52.66k - $62.69k
...Plan Reporting for Coverage Determinations and Redeterminations (CDR) ~Independent Review Organization (IRE) client reporting ~NCQA reporting ~Timeliness and Validation Reports Daily responsibilities include: ~Managing expected timeliness of reports ~...Full timeFlexible hoursNavitus Health Solutions, LLC
Remote7 days ago
