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- ...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...SuggestedFull timeWork at officeRemote work
DETROIT WAYNE Integrated HEALTH Network
Remote8 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
Remote17 hours 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...SuggestedFull 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...SuggestedHourly 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...SuggestedTemporary 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...SuggestedFull timeRemote workWork from homeFlexible hoursCurai
Remote17 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...SuggestedFull timeWork at officeRemote workWork from homeHome officeIncluded Health
Remote17 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 &...SuggestedFull timeContract workTemporary workRemote workWork from homeFlexible hoursAllara
Remote4 days 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...SuggestedFull timeRemote workHeadlight
Remote17 hours 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,...SuggestedFull timeWork at officeFlexible hours
Monogram Health
Remote1 day 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...SuggestedFull 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....SuggestedFull 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...SuggestedFull timeTemporary workFlexible hours
Matrix Medical Network
Remote5 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...SuggestedFull 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 ~...SuggestedFull timeFlexible hoursNavitus Health Solutions, LLC
Remote7 days ago- ...for credentialing JMG (Jefferson Medical Group) and JeffCare PHO physicians according to National Committee for Quality Assurance (NCQA). Works with Jefferson Medical Staff to ensure credentialing documentation is shared and coordinated as part of the JeffCare Credentialing...Daily paidFull timeTemporary workPart timeWork at officeFlexible hours
Jefferson Health Plans
Remote8 days ago $54.3k - $145.86k
...units to meet business needs and accomplish goals. ~Collaborate with colleagues to gather and prepare evidence of compliance for NCQA accreditation. ~Review analyses, policies, and other documentation against NCQA guidelines to confirm all accreditation requirements...Full timeCVS Health
Remote2 days ago$72.37k - $156.8k
...utilization, and performance. ~Act as a subject matter expert in HEDIS reporting and provide trainings as required. ~Stay current with NCQA standards and educate team as well as health plan analysts as needed. ~Lead initiatives with research, development, and...Full timeWork at officeMolina Healthcare
Remote1 day ago- ...Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician...Temporary workPrivate practiceRemote workShift work
- ...Implementation Advance Planning Document (IAPD), particularly our planned expansion of the National Committee for Quality Assurance (NCQA) Data Aggregator Validation program. This role will provide NC HIEA with clinical informatics expertise, ensuring that complex...
$78k - $85k
...Spanish. Obtain and utilize clinical information to develop an individualized member care plan and clinician-centered care plan per NCQA guidelines. Assess members health status and care coordination needs. Collaborate with members' health care providers as...Remote jobFull timeNight shiftDay shiftAfternoon shift- ...to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing...Remote workWeekend work
- ...licenses, board certifications, malpractice insurance, and work history with complete accuracy. Ensure all credentialing files meet NCQA, TJC, CMS, and payer-specific requirements. Payer Enrollment and Maintenance Prepare, submit, and track enrollment...Remote jobFull timeWork at office
- ...Review and distribute all incoming mail as needed Support Payer Audits in accordance with Minute Clinic, Joint Commission and NCQA requirements Maintain provider files with the most current information/documentation Notify system analyst and leadership of any...Remote jobWork at office
- ...compliance frameworks, and member engagement strategies. ~ Ability to connect CQ fluency's value to key payor metrics (CAHPS, Stars, NCQA, HEDIS, MLR, HCQI, etc.). ~ Experience leading QBRs, strategic RFPs, and renewals in a consultative, data-driven manner. ~...Remote jobFull time
- ...Graduate degree or equivalent combination of education and experience PREFERRED EXPERIENCE: • Knowledge of, and familiarity with, NCQA, CMS, and State regulatory submission requirements • Experience working in a cross-functional, highly matrixed organization •...Remote jobFull timeWork at office
$46k - $65k
...Office (e.g. Word, Excel, and PowerPoint), email, internet required Knowledge of and experience with Joint Commission, CMS, and NCQA Regulations related to medical staff services and Commercial Payers Credentialing preferred Knowledge of and experience with database...Remote jobHourly payFull timeLocal areaShift work$19.78 - $26.7 per hour
...healthcare professionals and services meet all established federal and state standards, as well as National Committee for Quality Assurance (NCQA) standards. ~Collaborate and work closely with the medical staff office in each facility. ~Monitor and update medical licenses...Full timeTemporary workPart timeWork at officeRemote workLifepoint Health
Remote2 days ago- ...required Skills\Certifications Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Working knowledge of URAC, NCQA and CMS accreditations Must be able to work in an independent and creative manner. Excellent oral and written communication...Remote jobContract workCasual workWork at officeMonday to Friday
$73.6k - $123.2k
...ability to translate complex analytical findings into actionable recommendations for business and clinical stakeholders. ~Knowledge of NCQA HEDIS specifications, CMS quality programs, and healthcare performance measurement methodologies. ~Experience working in a...Full timeContract workEmergent Holdings
Remote4 days ago
