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- ...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
- ...Products Magazine's Top Practice Performance Health (Parent Company of Theraband and Biofreeze) first US Center of Excellence NCQA Back Pain Recognition Project First US Multi-location practice to be recognized This Job Is Ideal for Someone Who Is: Adaptable...SuggestedInternshipLive inFlexible hours
- ...team. This position is also responsible and accountable for maintaining the Health Plan’s compliance with all state regulations and NCQA standards for quality activities related to Quality Management. This includes managing medical policy development, quality of care,...SuggestedContract workWork experience placement
$89.07k - $162.8k
...regulations. Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/guidelines and the District of Columbia Contract. Acts as a liaison to MedStar Family Choice contracted vendors to facilitate...SuggestedContract workWork at office- ...experience in a behavioral health or community health setting is strongly preferred. Experience in principles of Quality Improvement, NCQA Standards, and Accreditation and Certification processes. Affordable Medical, Dental, and Vision insurance. 401K Retirement Plan...SuggestedWork at office
$20.34 - $30.39 per hour
...experience. Basic knowledge of Healthcare Effectiveness Data Information Set (HEDIS) and National Committee for Quality Assurance (NCQA). Project planning experience. To all current Molina employees: If you are interested in applying for this position, please...SuggestedRemote jobHourly payFull timeWork experience placementWork at office- ...assessments and follow-ups post-discharge Maintain bi-weekly patient touchpoints Perform detailed, audit-ready documentation aligned with NCQA standards Develop and execute individualized care plans Lead complex case management for high-risk populations Coordinate care...SuggestedRemote workMonday to Friday
$78.4k - $107.8k
...ensuring alignment with organizational goals. Required Qualifications 4+ years' experience with Medicare Advantage. Understanding of NCQA HEDIS measures, PQA measures, CMS Star Rating System and CAHPS/HOS survey system. Experience building relationships with physician...SuggestedFull timeApprenticeshipWork at officeMonday to Friday$80k - $160k
...healthcare quality improvement, program implementation, or consulting. Expertise in clinical quality measurement (e.g., AHRQ, CMS, NCQA) and improvement frameworks (e.g., IHI, Lean, Six Sigma, etc.). Demonstrated success in leading or facilitating QI collaboratives,...SuggestedWork at officeRemote work- ...opportunities/meetings. Coordinate and track annual client regulatory training requirements. Support regulatory accreditation audits (e.g., NCQA, URAC). Provide backup support to GH Auditor in performing client collaboration audits (e.g., BCBSMN monthly, HCSC quarterly and...SuggestedTemporary workRemote workWork from home
$85k
...stakeholders, and interdisciplinary team required. Ability to meet accreditation and quality standards including, but not limited to NCQA, PCMH, HEDIS through following defined procedures to assess, intervene and document interactions. Ability to work independently and...SuggestedWork at office- ...expenses and payments is maintained. Participates in projects associated with the regulatory and accrediting agencies such as JCAHO, NCQA, and DCRA in addition to other outside organizations and Medicare. Administrative Responsibilities Creates and distributes...SuggestedTemporary workWork at officeFlexible hours
- ...and long care term care settings and partners with ambulatory care coordination and care programs including Medicare, Medi-Caid, and NCQA required programs to address the holistic needs of our members and ensure they are getting the right care, at the right place, and...SuggestedLocal area
$52.12k - $57.46k
...enrollment applications to payers and follow up until in‑network status confirmed. ~ Ensure compliance with state/federal regulations, NCQA, TJC, CMS, and accrediting institutions. ~ Assist in developing/improving internal credentialing policies and procedures....SuggestedFull timeImmediate startFlexible hours$120.7k - $238.22k
...concurrent review, and retrospective review to ensure timely and compliant determinations. Ensures compliance with state Medicaid, NCQA, CMS, and contractual requirements including turnaround time standards. Partners with medical directors to ensure appropriate clinical...Suggested- ...preferred. Experience in working with psychosocially and medically complex patients is strongly preferred. Knowledge or experience with NCQA PCMH model is preferred. Must be able to work as part of a multidisciplinary team with constant collaboration within and across...Work at office
- ...Washington, DC. Requirements: Minimum 2 years of experience (Required) Must have experience as a Complex Case Manager (NCQA experience preferred) Experience in: Acute Hospital Long-Term Acute Care / Rehab / Skilled Nursing Admission Criteria...Contract workShift work
Lancesoft INC
Washington DCmore than 2 months ago - ...staffing complex programs and managing health care supply chains # Working knowledge of PCMH, team-based care # Working knowledge of NCQA and Joint Commission standards preferred Physical Requirements: The position involves everyday risk and discomforts, which...Contract workSeasonal workFlexible hours
- ...the credentialing and re-credentialing processes for healthcare providers and licensed staff. This role ensures compliance with HRSA, NCQA, Joint Commission, and other regulatory standards while maintaining accurate and complete provider credentialing files. The position...
$150k - $170k
...position is eligible for an annual incentive bonus, payable in accordance with policy. Click here for employee benefit information. NCQA is committed to being an employer of choice and fostering an inclusive culture and workplace. We are an Equal Opportunity Employer/...For contractorsWork at office3 days per week$95 - $100 per hour
...`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. Aids and acts as a resource to Initial Clinical Reviewers. Ensures documentation of all communications with medical...Part timeWork at office- ...the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory agencies and other objectives. How will you make an impact: Works with both internal...Full timeTemporary workWork at officeLocal area3 days per week1 day per week
$2,400 - $10,000 per month
...in the company 401(k) plan at a 3% contribution rate with the option to opt out. Responsibilities Knowledge of CMS Regulations and NCQA HEDIS Guidelines Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology...Daily paidLocal areaRemote workComplexCare Solutions
Washington DC20 hours ago$95 - $96 per hour
...`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines. Aids and acts as a resource to Initial Clinical Reviewers. Ensures documentation of all communications with medical office...Full timePart timeWork at officeImmediate startEvolent
Washington DC2 days ago$50 - $60 per hour
...Products Magazine's Top Practice Performance Health (Parent Company of Theraband and Biofreeze) first US Center of Excellence NCQA Back Pain Recognition Project First US Multi-location practice to be recognized This Job Is Ideal for Someone Who Is: Adaptable...Local areaFlexible hours$1,000 per month
...performance including (but not limited to): multi‑payor total cost of care management, clinical quality outcome management, patient safety, NCQA HEDIS quality performance, etc. Analyze, interpret and apply healthcare payor claims data around $PMPM, Unit/1000, $$/Unit metrics...Work at officeLocal areaFlexible hours$28.37 - $39.19 per hour
...appropriateness, while maintaining production goals and QA standards. Ensures day‑to‑day processes are conducted in accordance with NCQA and other regulatory standards. Responsibilities: Assures accuracy and timeliness of all applicable review type cases within contract...Remote jobContract workWork at officeLocal areaFlexible hours- ...preferred. Experience in working with psychosocially and medically complex patients is strongly preferred. Knowledge or experience with NCQA PCMH model is preferred. Must be able to work as part of a multidisciplinary team with constant collaboration within and across...Work at office
- ...healthcare data insights predictive analytics data-driven intervention platforms quality improvement cms star ratings qrs ncqa hedis risk score accuracy ehr interoperability big data integration revenue cycle management pharmacy solutions...
- ...The Village Pediatric & Wellness Center has been recognized as a PCMH practice with distinction in Behavioral Health Integration by NCQA. Company Description The Village Pediatric & Wellness Center serves a growing, mostly immigrant, multicultural, and multilingual...
