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Manager Ncqa Jobs in Georgia (NOW HIRING)

Bestica Healthcare

RN Case Manager

Atlanta, GA · On-site

Acute Hospital * Long Term Acute Care/Rehab/Skilled Nursing Case Management/Utilization Review ... NCQA (National Committee for Quality Assurance) * OSHA * The Joint Commission/Core Measure/National ...

HealthONE

Credentialing Representative

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... NCQA, CMS, DOI, state credentialing standards and HealthOne Alliance policies and procedures. This ... Enters provider data into appropriate data management systems * Performs all credentialing ...

HealthOne Alliance

Credentialing Representative

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... NCQA, CMS, DOI, state credentialing standards and HealthOne Alliance policies and procedures. This ... management systems • Performs all credentialing verifications necessary to complete the ...

HealthOne Alliance

Credentialing Representative

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... NCQA, CMS, DOI, state credentialing standards and HealthOne Alliance policies and procedures. This ... data management systems Performs all credentialing verifications necessary to complete the ...

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Working knowledge of NCQA preferred * Must be able to work in an independent and creative manner. * Ability to manage multiple projects and priorities * Adaptive to high pace and changing environment

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Manager Ncqa information

What is the difference between Manager Ncqa vs Quality Assurance Manager?

AspectManager NcqaQuality Assurance Manager
CertificationsNCQA accreditation, healthcare quality certificationsISO, Six Sigma, QA-specific certifications
Work EnvironmentHealthcare organizations, insurance companiesManufacturing, software, healthcare, various industries
Industry UsagePrimarily in healthcare and managed careBroadly across multiple industries
Primary FocusHealthcare quality standards, compliance, NCQA accreditationProduct/service quality, process improvement

The Manager Ncqa primarily focuses on healthcare quality standards and NCQA accreditation within healthcare organizations, ensuring compliance with industry-specific regulations. In contrast, a Quality Assurance Manager oversees quality processes across various industries, emphasizing product or service quality and process improvements. While both roles involve quality management, the Manager Ncqa is specialized in healthcare accreditation and compliance, whereas the Quality Assurance Manager has a broader scope across different sectors.

What are the main challenges a Manager NCQA faces during accreditation cycles, and how can they address them?

A Manager NCQA often encounters challenges such as keeping up with changing accreditation standards, ensuring organization-wide compliance, and coordinating documentation across multiple departments. Successfully navigating these challenges requires strong project management skills, proactive communication, and ongoing staff education. Building collaborative relationships with clinical, quality, and administrative teams is essential to streamline processes and maintain readiness for audits, which ultimately supports both accreditation success and continuous quality improvement.

What are the key skills and qualifications needed to thrive as a Manager NCQA?

To thrive as a Manager NCQA, you need in-depth knowledge of NCQA accreditation standards, quality improvement processes, and a background in healthcare administration or a related field. Familiarity with quality management software, data analytics tools, and NCQA certification are typically required. Exceptional leadership, communication, and problem-solving skills help drive compliance and foster a culture of continuous improvement. These capabilities are crucial for ensuring organizational adherence to accreditation standards and enhancing healthcare quality outcomes.

What is a Manager NCQA?

A Manager NCQA is a professional responsible for overseeing an organization's compliance with NCQA (National Committee for Quality Assurance) standards and accreditation processes. This role typically involves managing quality improvement initiatives, ensuring adherence to NCQA guidelines, preparing for audits, and coordinating cross-functional teams to achieve accreditation. The Manager NCQA often works within healthcare organizations or health plans and plays a crucial role in maintaining high standards of patient care and operational excellence.
What are the most commonly searched types of Ncqa jobs in Georgia? The most popular types of Ncqa jobs in Georgia are:
What cities in Georgia are hiring for Manager Ncqa jobs? Cities in Georgia with the most Manager Ncqa job openings:
Manager Ncqa jobs near you

RN Case Manager

Bestica Healthcare

Atlanta, GA • On-site

Other

Re-posted 21 days ago

Job description

Job Title

Experience: 3 years Required, Any Preferred Preferred Preferred Yes

Certs marked with * are preferred BLS Skills marked with * are preferred

Work Settings:

  • Acute Hospital
  • Long Term Acute Care/Rehab/Skilled Nursing

Case Management/Utilization Review:

  • Admission Criteria
  • Care coordination
  • Discharge Planning
  • Utilize InterQual Criteria
  • Utilize Milliman Guidelines

Utilization Review:

  • Admission Criteria Appeals and Denials
  • Concurrent Review
  • Continued Stay Reviews
  • Medical Necessity
  • Retrospective Review
  • Utilize InterQual Criteria
  • Utilize Milliman Guidelines

Regulatory:

  • CMS: Centers for Medicare and Medicaid Services
  • CPT (Current Procedural Terminology) coding and billing
  • Department of Health
  • DRG (Diagnosis Related Groups)
  • HEDIS (The Healthcare Effectiveness Data and Information Set) Measures
  • HIPAA guidelines (Health Insurance Portability and Accountability Act)
  • ICD 10 Coding
  • NCQA (National Committee for Quality Assurance)
  • OSHA
  • The Joint Commission/Core Measure/National Safety Goals
  • Workers Compensation

Unit Details:

  • Block
  • Days: - Nights: - Weekends: -
  • Yes Note: Within facility/scope of practice as needed

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