Ncqa Jobs

CVS Health is hiring a California-licensed Senior Analyst, Health Care Quality Management to lead delegation oversight and regulatory compliance for delegated clinical partners.

Experienced clinical abstractor needed to lead HEDIS/quality medical record abstraction, mentor peers, and support enterprise reporting at Presbyterian Healthcare Services.

Highmark is hiring a Credential Delegation Analyst to manage delegated credentialing programs and ensure NCQA and regulatory compliance across delegated entities.

Oscar Health is hiring an Associate, Credentialing Operations to drive provider data integrity, compliance, and credentialing quality within our hybrid New York team.

Lead a remote Utilization Management team at CVS Health to ensure compliant, high-quality clinical interventions and strong operational performance for member care.

Wellmark is hiring a Credentialing Manager to manage delegated credentialing operations, ensure compliance, and drive process improvements across provider enrollment and data-loading workflows.

Experienced nursing leader needed to oversee ambulatory care management programs, staff, and operations to advance value-based care and improve patient outcomes at USC Health Sciences Campus.

A nonprofit pediatric health system is hiring a Corporate Credentialing Specialist to manage provider credentialing and privileging, maintain credentialing databases, and ensure regulatory compliance in a remote role.

Senior behavioral health leader sought to direct strategy, operations, and clinical standards for NeighborHealth’s Behavioral Health department while providing senior-level clinical care and leadership.

Join VillageMD as a Credentialing Specialist to own payer credentialing, privileging, and provider data management for a growing, value-based care organization.

Lead and develop remote oncology nursing teams at Thyme Care as an Oncology Nurse Manager focused on clinical quality, NCQA compliance, and scalable people-management practices.

Mass General Brigham seeks a detail-oriented Medical Staff Specialist to oversee credentialing, privileging, and compliance processes for physicians and advanced practice providers across its hospital network.

Presbyterian Health Plan is hiring a Quality Improvement Abstractor to perform medical record retrieval, abstraction and reporting in support of HEDIS, STARs and other quality initiatives.

Finni Health is hiring a Credentialing Manager to lead payer network growth, manage enrollment operations, and drive RCM efficiency at a rapidly scaling autism care platform.

Synapticure is hiring a Licensing and Credentialing Specialist to manage payor enrollment, state licensure, and credentialing for a growing nationwide telehealth provider network.

Lead pharmacy clinical transformation efforts at Innovaccer by serving as the quality-measure expert, enabling value realization, and partnering with customers and internal teams to scale clinical programs.

A detail-oriented Credentialing Specialist is sought to manage multi-state provider credentialing, payer enrollment, and privileging processes for QualDerm Partners, ensuring compliance and timely onboarding for assigned regions.

Experienced credentialing leader needed to manage committee operations, compliance, and a team of credentialing staff at HCSC's Richardson, TX office in a hybrid role.

Serve as TMH's Quality Improvement Coordinator, driving clinical quality, compliance, and process improvement across group practices and hospital services.

Medical Staff Services Specialist I needed to manage provider credentialing, maintain credentialing databases and files, and perform related administrative duties for SIU Medicine in a remote capacity.

Senior physician executive needed to serve as Presbyterian Health Plan's Chief Medical Officer to lead clinical strategy, quality, pharmacy and population health initiatives across New Mexico.

Experienced denial specialist needed to manage appeals, liaise with payers and physicians, and drive denial trend remediation for UChicago Medicine Ingalls Memorial's Revenue Cycle team.

Wellmark Blue Cross and Blue Shield seeks a Network Program Manager in Des Moines to lead network contracting and compliance initiatives for Medicare Advantage, QHP and provider network programs in a hybrid role.

Senior client-facing leader needed to grow strategic payer relationships, drive account profitability, and lead implementation of specialty benefits management programs for HealthHelp (a WNS Company).

Senior leader responsible for national credentialing and payer enrollment operations, compliance, automation, and team development at Privia Health.

Presbyterian Healthcare Services is hiring a Medical Standards Research Coordinator to lead research and development of medical coverage policies and benefit determination guidelines for its statewide health plan.