Ncqa Jobs

Medical practice in Ahwatukee hiring a part-time Credentialing Specialist to manage provider credentialing, payer enrollment, and re-credentialing to maintain compliance and reimbursement.

Oscar Health is hiring a clinically licensed Manager of Clinical Policy to evaluate vendor medical policies, ensure compliance and quality, and support affordability initiatives across the organization.

Experienced RN leader needed to design and run Gravie's clinical Quality Assurance program, ensuring regulatory compliance, accreditation readiness, and high-quality member care across clinical operations.

Centene is seeking a Quality Improvement Analyst (CPHQ) to lead statistical analysis and reporting of HEDIS, utilization, and quality measures using PowerBI and Snowflake/SQL.

Lead Centene's behavioral health utilization management team in a remote Florida-based Senior Director role focused on clinical quality, policy, operations, and cross-functional leadership.

Lead Brellium’s behavioral health clinical quality efforts by building and scaling QA programs, translating AI insights into actionable improvements, and partnering with customers and product teams to elevate documentation, compliance, and care quality.

Experienced denial specialist needed to manage claim appeals, payer relations, and denial trend analysis for UChicago Medicine Ingalls Memorial's Revenue Cycle team in a primarily remote, hybrid role.

Dental Insurance

Disability Insurance

Vision Insurance

Equity

Paid Time-Off

Medical Insurance

Mental Health Resources

Paid Holidays

Company Retreats

Hims & Hers is hiring a seasoned Credentialing Analyst to ensure provider compliance, run large-scale data reconciliations, and drive process improvements across a remote-first credentialing program.

Lead the Medical Staff Office at UM Rehab & Ortho Institute to manage credentialing, privileging, regulatory compliance, and medical staff governance while supervising operational staff.

Experienced nurse leader needed to lead PHP's clinical quality programs, accreditation efforts, and population health initiatives in Albuquerque to advance care quality and regulatory compliance.

Provide comprehensive credentialing and privileging support for AHN by verifying practitioner credentials, maintaining compliant records, and coordinating credentialing committee materials.

Lead and coordinate quality improvement and accreditation activities for CVS Health's Illinois FIDE program, ensuring NCQA, state and federal compliance while supporting population health and health equity efforts.

Humana is hiring a remote QA External LTSS Oversight Professional in Michigan to conduct compliance audits, analyze LTSS vendor performance, and ensure adherence to MDHHS, CMS, and NCQA standards.

Senior Quality Improvement Specialist needed to lead multi-faceted quality, accreditation, and performance improvement initiatives for a large national healthcare organization.

Experienced board-certified physician needed to lead medical necessity determinations, utilization management, and clinical policy for Presbyterian Health Plan, helping drive quality, cost-effective care for New Mexico members.

CareSource is hiring a Health Plan Data Analyst II to lead provider data analysis and reporting using SQL, Cognizant Facets, and Power BI to support network operations and quality improvements.

PHH Peak Health seeks a Remote Clinical Appeals Coordinator (RN) to conduct medical necessity appeals reviews, summarize findings for medical leadership, and ensure timely, compliant appeal resolutions.

Experienced HEDIS project manager needed to oversee annual HEDIS operations, lead seasonal teams, and ensure NCQA/STAR compliance in a fully remote capacity.

Experienced HEDIS Project Manager needed to lead and execute the annual HEDIS program remotely, overseeing seasonal teams and ensuring quality and compliance across measures.

Lead and manage the annual HEDIS program remotely as a HEDIS Project Manager, overseeing seasonal staff, ensuring NCQA/STAR compliance, and driving quality performance for a healthcare organization.

A Clinical Quality Nurse at Dell Medical School will lead CQI projects, analyze clinical data, and drive patient safety and regulatory readiness across clinical teams.

Experienced RN or LPN/LVN needed to perform utilization review and clinical case assessments for HealthHelp’s specialty benefits management team in Houston, ensuring compliance and quality-driven care decisions.

Presbyterian Healthcare Services is hiring a detail-oriented Provider Enrollment Coordinator to process and manage payer enrollment applications and maintain credentialing files to ensure providers can bill for services.

Experienced credentialing leader needed to oversee non-delegated provider credentialing and payer enrollment across a national dermatology network, driving compliance, timeliness, and team performance.