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Ncqa Jobs in Virginia (NOW HIRING)

Evolent

Cardiology Physician

Arlington, VA · On-site

$407K - $460K/yr

... Assurance (NCQA) guidelines. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner. * Participates in on-going ...

AMN Healthcare

General Pediatrician

Norfolk, VA · On-site

$200K - $220K/yr

Work in an NCQA-recognized patient-centered medical home * Bring strong charting, documentation, responsiveness, and communication skills to the role Community Information Suffolk, Virginia, is a ...

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Ncqa information

What is an NCQA?

An NCQA job typically involves working with healthcare organizations to ensure compliance with the National Committee for Quality Assurance (NCQA) standards. Professionals in these roles help organizations achieve accreditation or certification by implementing quality improvement processes, conducting audits, and analyzing data. Common NCQA-related positions include quality assurance specialists, accreditation consultants, and analysts who focus on managed care, population health, and performance measurement. These roles require knowledge of NCQA guidelines, healthcare regulations, and data analysis to support quality improvement initiatives.

What are the common responsibilities of an NCQA professional?

Professionals in NCQA roles are typically responsible for overseeing compliance with accreditation standards, conducting audits and quality assessments, and preparing documentation for NCQA reviews. They often collaborate with clinical and administrative staff to implement process improvements and ensure data accuracy in quality reporting systems such as HEDIS. Regular responsibilities may also include training teams on best practices, staying updated on changing quality standards, and leading initiatives to drive higher healthcare quality outcomes. This position offers meaningful opportunities to impact patient care and opens pathways to advanced roles in healthcare quality management.

What skills and qualifications are needed for an NCQA position?

To thrive in an NCQA (National Committee for Quality Assurance) role, candidates typically need a strong background in healthcare quality assurance, data analysis, and knowledge of accreditation standards, often supported by a degree in healthcare administration or a related field. Familiarity with quality measurement tools, reporting systems like HEDIS, and NCQA accreditation processes or certifications is highly valued. Strong attention to detail, organizational skills, and the ability to communicate effectively with multidisciplinary teams set exceptional candidates apart. These skills are essential to ensure compliance, improve care quality, and navigate the complex requirements of healthcare accreditation.

Is NCQA a good place to work?

NCQA (National Committee for Quality Assurance) is a reputable organization known for its focus on healthcare quality standards. Employees often cite a professional work environment, opportunities for growth, and the importance of certifications and compliance in their roles. As with any organization, individual experiences may vary based on position and department.

What are popular job titles related to Ncqa jobs in Virginia?

For Ncqa jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Ncqa jobs in Virginia look for?

The top searched job categories for Ncqa jobs in Virginia are:

What cities in Virginia are hiring for Ncqa jobs?

Cities in Virginia with the most Ncqa job openings:

Ncqa jobs near you
Infographic showing various Ncqa job openings in Virginia as of August 2026, with employment types broken down into 6% As Needed, 75% Full Time, 13% Part Time, and 6% Contract. Highlights an 81% In-person, and 19% Remote job distribution.

Remote Cardiology, Physician Clinical Reviewer

Evolent

Arlington, VA • On-site, Remote

Other

Posted 28 days ago

Evolent rating

8.4

Company rating: 8.4 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

73rd of 500 rated business services

Job description

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.



Collaboration Opportunities:  


  • Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers.



What You Will Be Doing:


  • Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.

  • Provides clinical rationale for standard and expedited appeals.

  • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.

  • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.

  • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.

  • Participates in on-going training per inter-rater reliability process.

  • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.

  • On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.



Qualifications - Required and Preferred:


  • MD/DO/MBBS Degree

  • Current, unrestricted clinical license in medicine or required specialty

  • Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs

  • Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease

  • Strong clinical, management, communication, and organizational skills

  • Energetic and curious with a passion for quality and value in health care

  • Computer Proficiency

  • Minimum of five (5) years’ experience in the practice of Cardiology is preferred

  • Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.

  • No history of a major disciplinary or legal action by a state medical board

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