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NCQA Remote Jobs

33 fresh jobs found

Patient Care Advocate
Remote-AR, United States

Centene Corporation

Member advocacy Provider experience Quality Initiatives Health administration HEDIS NCQA CPT coding Health coaching Risk Adjustment +34

USD 52K+

Health Plan Data Analyst II (SQL required)
Mississippi WFH, United States

Provider network Provider data management Provider Recruitment Facets NCQA Microsoft Access Certification Performance Improvement Visio +24

USD 55K+

Lead Grievance & Appeals Coordinator
Remote-CA, United States

Centene Corporation

Grievance Management Appeals processing Grievance Ncqa standards NCQA Compliance monitoring Report Preparation Health Plan Appeals +21

Senior Mid Full Time

USD 44K+

Clinical Business Strategy Lead
Dayton WFH, United States

URAC NCQA Clinical operations Negotiating Business Processes Regulatory requirements Managed Care Business strategy Medicare +19

Senior Mid Full Time

USD 81K+

Appeals Specialist II
Remote-TX, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Mid Full Time

USD 40K+

Clinical Appeals Nurse
Mississippi WFH, United States

MDCH regulations URAC State hearings OAC Proper grammar usage Clinical appeals Phone Etiquette Facets Critical Listening +22

Exec Mid Full Time

USD 55K+

Healthcare Quality Business Development Specialist
Dayton WFH, United States

Epidemiological Studies RFP writing NCQA Quality improvement Content development Quality Management Managed Care Assessment Outlook +20

Senior Full Time

USD 70K+

Enterprise Clinical Quality Analyst II
Dayton WFH, United States

Ncqa standards NCQA Provider Relations Microsoft Access Credentialing Healthcare Knowledge Performance Improvement CMS Clinical Experience +32

USD 61K+

Director, Configuration Implementation
Dayton WFH, United States

API-driven automation Payer platform configuration Guidingcare Implementation Strategy Facets System integrations NCQA Healthcare Regulations System Configuration +28

Exec Senior Full Time

USD 110K+

Director, Market Quality Improvement
Mississippi WFH, United States

NCQA Provider engagement Healthcare Management Financial Forecasting Accreditation Performance Improvement Stakeholder Collaboration Quality improvement Business Processes +29

Exec Senior Full Time

USD 99K+

VP, Market Chief Medical Officer(Must live in Wisconsin & Open To Relocation)
Wisconsin WFH, United States

Patient-centered medical homes Health outcomes disparity Peer review processes Clinical thought leadership Health system transformation Provider network Quality rating improvement Healthcare affordability Accountable care organizations +40

Exec Senior Full Time

USD 250K+

Behavioral Health Medical Director - Medicaid
Remote US, United States

Computer-Based Review CGX Community Groups Clinical reference materials CMS policies Medical background MCG Medical Director Clinical evaluation +48

Exec Senior Full Time

USD 223K+

Senior Manager, Healthcare Analytics
Remote-MO, United States

Centene Corporation

Table creation QRS Data design Quality measures Stored Procedures Query optimization Data verification NCQA Microsoft Power BI +64

Senior Full Time

USD 105K+

Maternity Clinical Practice Advisor
Remote-NV, United States

Centene Corporation

Maternal care Utilization metrics Clinical Practice Guidelines RN licensure Community partnerships Clinical Initiatives Quality performance Billing practices Clinical Standards +43

USD 68K+

Provider Engagement Specialist III
Mississippi WFH, United States

Market performance Provider Recruitment Provider network management Critical Listening NCQA Healthcare Compliance Provider engagement Network management Accreditation +33

Senior Mid Full Time

USD 63K+

Quality Practice Advisor
Remote-IL, United States

Centene Corporation

Clinical Relationship Management Cphq Documentation standards Risk Adjustment Coding Medical record documentation NCQA Provider education Health Plan HEDIS +23

USD 52K+

Senior HEDIS Medicaid Data Manager
Remote US, United States

Medicaid data Large data sets STARS Dynamic Environment Visualizations NCQA HEDIS Control Data interpretation +50

Senior Full Time

USD 97K+

VP, PHCO Utilization Management Medicaid & Marketplace
Remote-MO, United States

Centene Corporation

Ncqa standards NCQA Clinical Training Financial Forecasting Provider Relations Acute care Marketplace Reconciliation Utilization Review +25

Exec Senior Full Time

USD 182K+

Appeals Specialist II
Remote-NY, United States

Centene Corporation

Appeals processing NCQA Accreditation Logging Appeals Medical management Health Services Procedures Outreach +14

Entry Full Time

USD 40K+

Clinical Review Clinician - Appeals (RN)
Remote-TX, United States

Centene Corporation

Appeals process Interdepartmental Collaboration Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity Medical Records +23

USD 95K+

Patient Care Advocate
Remote-ME, United States

Centene Corporation

Member advocacy Quality Initiatives Provider experience NCQA Health administration Telephonic Communication HEDIS Risk Adjustment Telephonic Outreach +35

USD 52K+

Part Time Medical Director(Appeals Experience Preferred)
Dayton WFH, United States

Clinical case review Medical consultation Performance evaluations Systematic Thinking Data Sharing Clinical reviews Critical Listening NCQA Provider education +17

Exec Senior Part Time

USD 191K+

Supervisor, Clinical Grievance and Appeals
Remote-MO, United States

Centene Corporation

Grievance Ncqa standards Grievances NCQA Quality Metrics Medical necessity Clinical operations Appeals Medical management +28

USD 68K+

Transition of Care Managers - RN and LSW - Must live in Mississippi
Mississippi WFH, United States

LSW Inter-disciplinary teamwork Person-centered planning Clinical Standards Critical Listening NCQA Health Equity Health Assessments Trauma-Informed Care +29

USD 55K+

Care Manager-Mom & Baby Beginnings-Must reside in Mississippi
Mississippi WFH, United States

Person-centered planning Healthcare Resource Utilization Clinical Standards Interdisciplinary Team Collaboration Critical Listening NCQA Health Equity Cultural Competence Health Assessments +29

USD 55K+

Care Manager NICU - RN and LSW (Must live in Mississippi) WFH
Mississippi WFH, United States

LSW Psychosocial Assessments Person-centered planning Healthcare Resource Utilization Clinical Standards Interdisciplinary Team Collaboration Critical Listening Health Equity NCQA +30

USD 55K+

Utilization Management Market Operations Manager (Must live in Mississippi)
Mississippi WFH, United States

NCQA Provider engagement Problem identification Regulatory reporting Resolution CMS Performance Improvement Visio Quality improvement +32

Senior Mid Full Time

USD 73K+

Value-Based Programs Lead (Data and Analytics)
Remote US, United States

CMS Payment Strategies PowerPlatform Functional strategies NCQA Data Extraction Value-based care Quality Metrics CMS Functions +42

Senior Full Time

USD 104K+

Quality Practice Advisor
Remote-IN, United States

Centene Corporation

Cphq Medical record documentation Risk Adjustment Coding Documentation standards NCQA Provider education ICD-9 Risk Adjustment HEDIS +19

USD 52K+

VP, PHCO Utilization Management - Medicare & Duals
Remote-FL, United States

Centene Corporation

NCQA Ncqa standards Clinical Training Financial Forecasting Provider Relations Acute care Utilization Review Medical management Training Programs +21

Exec Senior Full Time

USD 182K+

Accreditation Manager
Remote US, United States

Accreditation management NCQA Compliance Continuous process improvement Health Plan Experience Functional strategies NCQA Judgement Accreditation LESS +42

Senior Mid Full Time

USD 94K+

Clinical Review Clinician - Appeals
Remote-MO, United States

Centene Corporation

Appeals processing Interdepartmental Collaboration Clinical data analysis Ncqa standards Clinical reviews Medicaid regulations NCQA Clinical Review Medical necessity +25

USD 52K+

Senior Process Improvement Professional
Remote US, United States

Graph Creation Lucid NCQA Business practices Business Process Operational processes Lean Six Sigma Consumer Experiences Process design +54

Senior Full Time

USD 78K+

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