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Manager Ncqa Jobs in Tennessee (NOW HIRING)

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 ...

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 ...

Tovli

Psychiatric Nurse Practitioner

Chattanooga, TN · On-site

$110 - $140/hr

Develop and implement individualized treatment plans that may include medication management ... Participate in quality improvement initiatives such as utilization review and adherence to NCQA ...

Tovli

Psychiatric Nurse Practitioner

Chattanooga, TN · On-site

$125K/yr

Develop and implement individualized treatment plans that may include medication management ... Participate in quality improvement initiatives such as utilization review and adherence to NCQA ...

OneOncology

Credentialing Specialist

Nashville, TN · On-site

Database management/provider files. * Maintain vital provider credentialing information via ... Experience working with NCQA criteria and third-party payer regulations. * Experience with ...

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Manager Ncqa information

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 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 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 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 cities in Tennessee are hiring for Manager Ncqa jobs?

Cities in Tennessee with the most Manager Ncqa job openings:

Manager Ncqa jobs near you

Clinic Manager

Neighborhood Health

Nashville, TN • On-site

Full-time

Re-posted 29 days ago

Job description

Neighborhood Health is an innovative network of 12 community health centers in Nashville, Gallatin and Lebanon, Tennessee. We provide comprehensive primary care, integrated behavioral health, and dental services to almost 30,000 patients. Our patients primarily include immigrants, residents of public housing, individuals experiencing homelessness, and persons living with addiction. As a federally qualified health center, we provide care without regard to health insurance or a patient's ability to pay. We also strive to improve our Patient Centered Medical Home model to ensure all of our patients get the right high-quality care, at the right place, and at the right time.
NATURE OF POSITION: The Clinic Manager ensures all patients receive the highest quality primary, preventive, integrated behavioral health care. The Clinic Manager also ensures the clinic serves all patients in a prompt, efficient, and sensitive manner. 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 program (e.g., Vaccines for Children, Ryan White, etc.).
The Clinic Manager:
  • Has primary responsibility for clinic workflow during all operating hours of the respective clinic (including functioning as a "back up" medical assistant as needed);
  • Monitors logs and operational reports for accuracy and compliance with accreditation and program requirements; and
  • Proposes and, upon approval of the Clinic Director and Executive Team, implements refined business processes to achieve the intended outcomes.

Organizationally, the Clinic Manager is a member of the Clinical Operations team, working closely with the Clinic Director (CD), Customer Service Representatives (CSRs), Medical Assistants (MAs), Dental Assistants (DAs), Referral Specialists, Care Coordinators, Care Managers, and providers in facilitating direct patient care. While the Clinic Manager primarily serves one clinic site, the Clinic Manager may need to travel between sites and serve at alternative locations depending on the daily needs of the broader organization.
QUALIFICATIONS
  • LPN or MA with 5+ years MA/LPN experience
  • Licensed in Tennessee if LPN, or have a certificate of completion by an accredited MA program
  • Demonstrated experience in ambulatory, physician practice, or community health settings
  • Extensive technical knowledge and skills related to clinical duties
  • Demonstrated computer skills, with specific experience using an electronic health record software (we use NextGen)
  • Knowledge of privacy requirements of HIPAA and ability to handle and manage confidential information
  • Basic understanding of behavioral health and dental practice principals Supervisory/management experience preferred
  • Familiarity with Joint Commission accreditation standards and Vaccines for Children compliance requirements preferred
  • Proficiency in Spanish preferred
  • Demonstrated ability in the following competencies:
    • Excellent verbal and written communication skills
    • Ability to motivate and inspire
    • Critical "clinic-level" thinking regarding business process optimization
    • Interpersonal savvy with proficiency in developing and building relationships
    • Proven time management and priority setting skills
    • Ability to teach and work with people in a diverse population
    • Ability to speak clearly and to use tact and sensitivity with all patients
    • Ability to deal courteously and efficiently with providers, referral sources and other business representatives.

ESSENTIAL JOB FUNCTIONS:
  • Communicate any facility needs with Clinic Director or appropriate member of Operations Team.
  • Order and maintain supplies and equipment and ensuring clinic has adequate inventory and is well-stocked.
  • Ensure all clinic areas (including waiting rooms, exam rooms, bathrooms and staff work spaces) are well-maintained, clean, and safe.
  • Other duties as assigned
  • Orient new Medical Assistants and Customer Service Representatives in collaboration with support staff trainers.
  • Provide regular performance feedback to Medical Assistants and Customer Service Representatives.
  • Monitor and ensure that staff complete required annual e-training.
  • Complete annual Performance Evaluations for Medical Assistants and Customer Service Representatives using feedback from MA and CSR trainers, providers, and other members of the Operations Team.
  • Contribute to annual Performance Evaluations for Referral Specialists and enrollment staff as requested by the Clinic Director and Operations Team.
  • Participate in continuing education and staff meetings and committees as requested.
  • Participate in cross-training to assure ability to move among clinic support positions.
  • Assist all sites in necessary staffing as requested.
  • Maintain a strong and caring team with high morale and engagement.

Operational Efficiency:
  • Monitor clinical and front office staff to assure that the following processes are occurring appropriately:
    • Check-in and registration process is completed thoroughly, accurately and timely (including verification of eligibility, housing status and required UDS data).
  • Required forms and information are consistently provided to patient such as PHQ-9
  • Initial triage of patient is correctly entered into the EHR.
  • Intercede when providers receive calls or requests to complete forms in order to resolve the matter or task the issue to a provider for prompt resolution but without interrupting the provider or workflow.
  • Take initiative in assigning support staff to adjust for workload and assisting other team members whenever necessary and serve as a back-up for any front-desk position when needed (due to staff absences, unexpected demand for services, etc.).
  • Mentor/coach Medical Assistants and Customer Service Representatives and ensure they are abreast of any changes regarding policies, procedures, and protocols.
  • Assist Referral Specialists and enrollment staff and ensure their full integration into clinic flow.
  • Monitor the entered charges by providers to ensure charts are completed promptly.
  • Maintain an open line of communication with staff regarding any issues or concerns.
  • Monitor wait times of patients each day and intervene as needed to assure timely care.
  • Ensure that all patients are seen per policy and none are turned away.
  • Monitor proper management of cash receipts.
  • Assure patient satisfaction surveys are completed on set schedule.

Direct Care Delivery:
  • Ensure behavioral health staff are available to promptly see each individual patient as needed, either onsite or coordinated through telehealth.
  • Ensure all referrals from dental staff for persons who require follow up with hypertension or HIV receive prompt, same-day attention from medical providers.
  • Serve as a "back up" Medical Assistant when needed (due to staff absences, unexpected demand for services, etc.).
  • Ensure all patients whose primary language is not English have prompt access to real-time interpretation from a bilingual staff person or through the language assistance service.
  • Ensure Medical Assistants promptly, accurately, and consistently enter patient height, weight, vitals, and HIV test results (e.g., OraQuick tests) into electronic health record.
  • Ensure Medical Assistants and Customer Service Representatives scan all appropriate documentation and hard copy records and materials into electronic health record.
  • Ensure Medical Assistants properly stock work areas before the day begins.
  • Ensure all exam rooms are properly stocked for supplies needed for all types of visits including cervical cancer screening, child visits, etc.
  • Ensure each patient/parent/guardian leaves with a care plan that they understand.

Regulatory Compliance:
  • Ensure staff promptly, accurately, and consistently maintain all logs, inventory lists, etc.
  • Ensure all lab work is appropriately ordered and processed using approved techniques.
  • Inform company designee if machines malfunction, scales not calibrated, etc.
  • Understand and complies with:
    • Joint Commission patient safety standards including read-back, repeat orders, abbreviation use, etc.
    • Neighborhood Health policies
    • MSDS policies
    • OSHA's Blood-borne Pathogen Standard and related safety measures
    • Infection-control precautions and procedures
    • HIPAA and patient confidentiality standards
  • Ensure all appropriate staff are appropriately trained up to date on all VFC standards and required trainings are complete.
  • Monitor vaccine storage and handling, insuring that all indicated vaccines are available to be administered.
  • Monitors and assure that stock and PAP medication storage and distribution complies with NH policy and procedure, The Joint Commission, and OSHA.

Quality of Care
  • Ensure that patient care teams conduct pre-visit planning and are consistently prepared to provide high quality care for patients so as to close 100% of care gaps during the encounter.
  • Monitor morning huddles to ensure that care gaps are discussed and adequate preparations made to close all such gaps.
  • Facilitate monthly clinic meetings to discuss quality indicators, PDSAs, and initiatives to improve quality.
  • Oversee follow up on referrals and diagnostic testing to ensure that results are promptly returned and reviewed by providers.
  • Obtain provider feedback on clinic process and personnel and address or pass on as needed.
  • Accept, review and resolve patient complaints if possible, or pass on as needed.
  • Other duties as assigned.

SALARY GRADE AND CLASSIFICATION: Exempt
STATUS: Full-time
SUPERVISORY RESPONSIBILITIES: Direct
RESPONSIBLE TO: Clinic Director
PHYSICAL REQUIREMENTS
The essential job functions of the Clinic Manager:
  • Are varied in nature and must be successfully performed in the context of frequent interruptions.
  • Require close attention to detail, accuracy, documentation and timeliness in fulfilling duties and reports.
  • Require reading for extended periods.
  • Require normal movement (e.g., sitting, standing, and/or walking for periods of five hours or more) with limited lifting e.g., moving and examining objects at high and low reach);
  • Must be performed in an environment with limited clinical safety hazards.

The Clinic Manager must:
  • Report to work at location as assigned by Clinic Director;
  • Have sufficient manual dexterity to operate telephone system, computer keyboard, copier, fax, or other office, or medical equipment;
  • Be sufficiently mobile (standing, walking and reaching) to access and utilize required equipment, supplies and resource material with reasonable accommodation; and
  • Possess sufficient vision and hearing acuity to see and hear callers, team members and patients with reasonable accommodation.

LOCATION: Various clinic sites as assigned; travel is required.
EOE

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