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Manager Ncqa Jobs in Tennessee (NOW HIRING)

Neighborhood Health

Manage accreditation/recognition status and ensure ongoing compliance with NCQA, The Joint Commission (TJC), and select HRSA programs * Assemble, upload, and submit all required NCQA submissions to ...

tnhealth

Grievances and Appeals Coordinator

Franklin, TN · On-site

$21.75 - $27/hr

Knowledge of NCQA, HEDIS or general accreditation requirements and guidelines for utilization management, denials and appeals. Familiarity with Appeals processes and regulatory requirements related ...

tnhealth

Grievances and Appeals Coordinator

Franklin, TN · On-site

$21.75 - $27/hr

Knowledge of NCQA, HEDIS or general accreditation requirements and guidelines for utilization management, denials and appeals. Familiarity with Appeals processes and regulatory requirements related ...

University of Rochester

$27.16 - $38.03/hr

... management with the NCQA Accreditation application & survey process which includes completing the online application, coordinating the payments and scheduling of the survey, and participating in the ...

Global Channel Management

Pharmacist

Chattanooga, TN · On-site

$53 - $63.75/hr

... NCQA, EQRO, CMS) required Knowledge of medical and pharmacy products License Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee Pharmacist duties:

Neighborhood Health

Additionally, the Clinic Manager has primary responsibility for ensuring full compliance within the clinic with all accreditation standards (e.g., from the Joint Commission and NCQA) and specific ...

Neighborhood Health

Additionally, the Clinic Manager has primary responsibility for ensuring full compliance within the clinic with all accreditation standards (e.g., from the Joint Commission and NCQA) and specific ...

Neighborhood Health

Clinic Manager

Nashville, TN · On-site

Additionally, the Clinic Manager has primary responsibility for ensuring full compliance within the clinic with all accreditation standards (e.g., from the Joint Commission and NCQA) and specific ...

New

Shearwater Health

Sr Compliance Specialist

Nashville, TN · On-site

... NCQA where applicable. * Document audit findings, identify root causes and provide actionable recommendations. * Collaborate with internal and external stakeholders to manage corrective action plans ...

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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 cities in Tennessee are hiring for Manager Ncqa jobs? Cities in Tennessee with the most Manager Ncqa job openings:
Manager Ncqa jobs near you

Director of Policy, Compliance, and Innovation

Neighborhood Health

On-site

Full-time

Medical, Dental

Re-posted 4 days ago

Job description

Neighborhood Health is a nonprofit federally qualified health center with 12 locations in Nashville, Lebanon, and Gallatin. We have proudly served the people of Middle Tennessee for almost 50 years without regard to their insurance status or ability to pay. Today, we provide medical, prenatal, dental, and behavioral health care to over 30,000 people of all ages, more than half of whom have no health insurance. Neighborhood Health may be the most interesting medical practice in the region: We have two clinics focused on public housing communities, two clinics focused on immigrants and refugees, two clinics focused on those experiencing homelessness, and two clinics in rural areas. Because of the trust we have earned with patients, Neighborhood Health has become the largest safety net provider of primary care in Middle Tennessee – and the largest both for African Americans and for Hispanic residents. Neighborhood Health holds accreditation from The Joint Commission and was one of the first multi-site group practices in Tennessee to achieve NCQA recognition as a Patient-Centered Medical Home.
Our Mission: Neighborhood Health is dedicated to improving the health of our community by eliminating barriers to care and serving as a healthcare home without regard to the ability to pay.
Position Description
The Director of Policy, Compliance, and Innovation works closely with members of the Executive Team to design and implement new workflows and business processes to achieve highly specific business goals. The Director provides a true systems perspective to ensure each employee or partner involved a workflow can complete their specific tasks as efficiently and effectively as possible. The Director also has primary responsibility to design and track key management reports to identify potential obstacles or points of failure and resolve issues there as they arise. Using a rapid-cycle, iterative Plan-Do-Study-Act (PDSA) approach, the Director assesses and helps implement potential improvements.
The Director performs this work by quickly becoming steeped in technical requirements of key partners as these evolve. The Director develops a thorough understanding of The Joint Commission accreditation requirements, the NCQA recognition standards for Patient-Centered Medical Home recognition, and the HRSA requirements for federally qualified health centers (including those related to the FTCA malpractice program). The Director also develops expertise in the requirements of contract agreements with key partners, including but not limited to TennCare managed care organizations (MCOs) and Medicare Accountable Care Organizations (ACOs). Given the importance of these programs to the Directors work, the Director has primary responsibility for liaising with these partners and ensuring Neighborhood Health’s documented adherence to their respective requirements. The Director also has primary responsibility for overseeing Neighborhood Health’s Risk Management and Patient Safety Plan and shared responsibility for the implementation and monitoring or our Quality Improvement-Quality Assurance Plan.
Qualifications:
  • Bachelor’s degree plus 4 years relevant work experience; or 6 years of relevant work experience in a community-based organization, public health or health care setting.
  • Knowledge of, and ability to accommodate, the social, cultural and linguistic needs of people from diverse backgrounds.
  • Highly proficient in project planning and management with strong organizational skills, including the ability to manage several projects simultaneously, respond to tight timelines and operate effectively in a fast-paced, detail-rich environment.
  • Excellent oral and written communication skills with a demonstrated awareness of the individual needs of clients and communities.
  • Diplomatic skills and the ability to exercise proper judgement, discretion, and be flexible in response to changing organizational needs.
  • Highly motivated with an ability to work independently and as a collaborative member of a team
  • Ability to work with a minimum of supervision
Responsibilities:
  1. Develop and implement “start-up” initiatives
  1. Propose initiatives to improve organizational performance consistent with the annual strategic foci and broader Strategic Plan;
  2. Design, test, and implement new workflows, new business processes, and/or new business units;
  3. Develop project plan to transition successful “start-ups” to an appropriate, embedded place within the organization;
  1. Manage accreditation/recognition status and ensure ongoing compliance with NCQA, The Joint Commission (TJC), and select HRSA programs
  1. Assemble, upload, and submit all required NCQA submissions to the NCQA PMCH platform and manage all components of the NCQA process to maintain PCMH recognition for all locations;
  2. Assemble, upload, and submit all required submissions to The Joint Commission and manage all components of the TJC process to maintain ambulatory care and PMCH accreditations;
  3. Assemble and upload the following submissions to HRSA’s Electronic Handbook (EHB) so the CEO can submit prior to the deadline:
    1. FTCA annual re-application;
    2. Progress reports (except financial reports) on grants administered by HRSA;
  4. Ensure the organization drafts and presents to the Board:
    1. Annual risk management report, which includes completed risk management activities, a compilation of near misses and adverse events, status of the health center’s performance relative to established risk management goals, and proposed risk management activities that relate and/or respond to identified areas of high organizational risk (normally in May);
    2. Updated Hazard Vulnerability Analysis (normally in May)
    3. Updated Prioritized Risk of Infection Analysis (normally in May)
    4. Updated Risk Management Training Plan (normally in November)
    5. Updated Environment of Care (ECO) goals (normally in November)
    6. Updated Needs Assessment (with ZIP code analysis) on an annual basis (normally in early March);
    7. Updated Patient Experience Analysis (normally in March).
  1. Manage Patient Centered Medical Home (PCMH) programs with TennCare managed care organization (MCO)
  1. Design, test, and implement business processes to improve organizational performance and maximize revenue;
  2. Supervise a limited number of PCMH staff, specifically regarding patient outreach and engagement activities;
  3. Generate patient outreach lists using Azara and other tools in a HIPAA-compliant manner;
  4. Monitor performance and regularly brief the CEO;
  5. Serve as PCMH liaison with each MCO and serve as organizational representative at monthly meetings to share program performance updates;
  6. Attend regional MCO collaborative meetings throughout the year;
  1. Manage social determinants of health (SDoH) programs with TennCare managed care organization (MCO) in collaboration with the CEO
  1. Design, test, and implement business processes to improve organizational performance and maximize both “grant” funding and reimbursement claims/revenues;
  2. Monitor performance and regularly brief the CEO;
  3. Produce grant reports as assigned by the CEO;
  4. Collect and curate “success” stories for funders;
  5. Serve as SDoH liaison with each MCO;
  1. Manage value-based care and accountable care organization (ACO) initiatives
  1. Design, test, and implement business processes to improve organizational performance to:
    1. Maximize reimbursements/revenues;
    2. Minimize administrative burden and payer-specific deviations from workflows of providers and staff;
  2. Monitor performance and regularly brief the CEO;
  3. Serve as SDoH liaison with each payer or ACO;
  4. Ensure we generate and send (by email, mail, etc.) the semi-annual patient notices required by federal regulations and ACO agreements;
  1. Manage certain IT related functions
  1. Manage user access to Azara population health;
  2. Manage alerts on daily huddle reports;
  3. Manage appointment reminder content and cadence;
  4. Manage patient outreach campaign content and population health reports for them;
  5. Conduct root cause analysis when staff report possibly issues with patient communications and automated scheduling;
  6. Manage patient self-scheduling and appointment accelerator parameters and provider changes.
  1. Manage virtual programs
  1. Manage the Collaborative Practice Agreement and Pharmacy Fellowship programs through Belmont College of Pharmacy and Health Sciences.
  1. Maintain comprehensive policy library
  1. Ensure written policies conform to style standards (e.g., use of clear subjects with active tense verbs, etc.);
  2. Ensure we have all required policies to comply with federal and state rules, accreditation standards, and contract obligations;
  3. Maintain accurate, up-to-date inventory of policy documents and ensure each is available on SharePoint;
  4. Track due dates for reviews of policies, protocols, and other key documents and ensure appropriate leadership team members complete revisions at least 60 days prior to the “revise by” date so as to allow for reviews by staff-level and Board committees;
  5. Draft new policy documents upon request (or with approval) of Chief Executive Officer (CEO);
  1. Manage regulatory compliance processes
  1. Submit RDH xray registrations in consultation with the Director of Dental Services;
  2. Ensure timely submission of CLIA waiver renewals, etc.;
  3. Ensure timely submission of TDMHSAS annual licensure renewal;
  4. Ensure timely submission of Ryan White Program Services Report (RSR) (normally in February) and quarterly Ryan White updates;
  5. Monitor compliance with patient notifications regarding abnormal Paps, Cologuard test results, INR test results (for patients taking warfarin), etc. and produce quarterly quality reports;
  6. Monitor compliance with on-call provider response time each week and produce quarterly quality reports;
  7. Provide back up to the Privacy Officer on HIPAA-related matters;
  1. Support overall clinic compliance efforts by backing up the Quality Coordinator with the following activities:
  1. Conduct clinic tracers;
  2. Assume allocated compliance responsibilities to manage fire drills, sign audits, etc. at specific locations;
  3. Investigate and document findings for incident reports assigned for review;
  4. Investigate and document findings for patient complaints assigned for review;
Miscellaneous:
  • Completes FTCA-required risk management training each year (normally by June 30th).
  • Other duties as assigned.
Status: Exempt
Reports to: Chief Information Officer with secondary reporting line to Chief Clinical Officer
EOE

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