Dir Provider Network Mgmt
Raleigh, NC · On-site
Drives Company-wide and Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC. * Ensures the achievement of financial, quality, and clinical objectives through accomplishment of provider ...
Dir Provider Network Mgmt
Raleigh, NC · On-site
Drives Company-wide and Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC. * Ensures the achievement of financial, quality, and clinical objectives through accomplishment of provider ...
Ensure all reviews and engagements align with URAC, NCQA, and internal quality standards. * Document peer interactions and clinical decisions in a timely and accurate manner. * Participate in ...
Ensure all reviews and engagements align with URAC, NCQA, and internal quality standards. * Document peer interactions and clinical decisions in a timely and accurate manner. * Participate in ...
Appeals Analyst
Chapel Hill, NC · On-site
$50K - $80K/yr
... NCQA), ASO group performance guarantees and BCBSNC policies and procedures (to include BCBSA requirements). What You Bring * Bachelor's degree or advanced degree where required. * 3 years of related ...
Appeals Analyst
Chapel Hill, NC · On-site
$50K - $80K/yr
... NCQA), ASO group performance guarantees and BCBSNC policies and procedures (to include BCBSA requirements). What You Bring * Bachelor's degree or advanced degree where required. * 3 years of related ...
... NCQA, CMS, and AAAHC Standards for health plans, hospitals, ambulatory care centers, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online ...
... NCQA, CMS, and AAAHC Standards for health plans, hospitals, ambulatory care centers, and patient care facilities. Maintain up-to-date data for each provider in credentialing databases and online ...
Dir Provider Network Mgmt
Raleigh, NC · Remote
Drives Company-wide and Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC. * Ensures the achievement of financial, quality, and clinical objectives through accomplishment of provider ...
Dir Provider Network Mgmt
Raleigh, NC · Remote
Drives Company-wide and Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC. * Ensures the achievement of financial, quality, and clinical objectives through accomplishment of provider ...
Payer Healthcare Data Scientist, Manager
Raleigh, NC · On-site
$99K - $232K/yr
... NCQA HEDIS specifications and CMS Star Ratings - Knowledge of government payer programs and Medicaid - Experience with NLP or unstructured clinical text - Exposure to social determinants of health ...
Payer Healthcare Data Scientist, Manager
Raleigh, NC · On-site
$99K - $232K/yr
... NCQA HEDIS specifications and CMS Star Ratings - Knowledge of government payer programs and Medicaid - Experience with NLP or unstructured clinical text - Exposure to social determinants of health ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
Patient Service Representative
Lillington, NC · On-site
$14.75 - $18.75/hr
Assists in obtaining and maintaining NCQA PCMH recognition; * Faxing patient correspondence to outside entities from providers. This can include paper or electronic faxes depending on the type of fax ...
Quick apply
Patient Service Representative
Lillington, NC · On-site
$14.75 - $18.75/hr
Assists in obtaining and maintaining NCQA PCMH recognition; * Faxing patient correspondence to outside entities from providers. This can include paper or electronic faxes depending on the type of fax ...
... 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 ...
... 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 ...
Patient Service Representative
Lillington, NC · On-site
$14.75 - $18.75/hr
Assists in obtaining and maintaining NCQA PCMH recognition; * Faxing patient correspondence to outside entities from providers. This can include paper or electronic faxes depending on the type of fax ...
Patient Service Representative
Lillington, NC · On-site
$14.75 - $18.75/hr
Assists in obtaining and maintaining NCQA PCMH recognition; * Faxing patient correspondence to outside entities from providers. This can include paper or electronic faxes depending on the type of fax ...
... NCQA) guidelines. * Provides clinical rationale for standard and expedited appeals. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely ...
... NCQA) guidelines. * Provides clinical rationale for standard and expedited appeals. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
Patient Service Representative
Lillington, NC · On-site
$14.75 - $18.75/hr
Assists in obtaining and maintaining NCQA PCMH recognition; * Faxing patient correspondence to outside entities from providers. This can include paper or electronic faxes depending on the type of fax ...
Patient Service Representative
Lillington, NC · On-site
$14.75 - $18.75/hr
Assists in obtaining and maintaining NCQA PCMH recognition; * Faxing patient correspondence to outside entities from providers. This can include paper or electronic faxes depending on the type of fax ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
Physician Reviewer-Radiology (Part Time)
$95 - $100/hr
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
Physician Reviewer-Radiology (Part Time)
$95 - $100/hr
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
... NCQA) guidelines. * Aids and acts as a resource to Initial Clinical Reviewers. * Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and ...
Ncqa information
See Raleigh, NC salary details
$28K - $54.6K
18% of jobs
$54.6K - $81.2K
1% of jobs
$81.2K - $107.8K
0% of jobs
$110.4K is the 25th percentile. Wages below this are outliers.
$107.8K - $134.4K
63% of jobs
$134.4K - $160.9K
15% of jobs
$160.9K - $187.5K
2% of jobs
$187.5K - $214.1K
1% of jobs
$214.1K - $240.7K
0% of jobs
$240.7K - $267.3K
0% of jobs
$267.3K - $293.8K
0% of jobs
$293.8K - $320.4K
1% of jobs
$28K
$126.7K
$320.4K
How much do ncqa jobs pay per year?
As of Jun 16, 2026, the average yearly pay for ncqa in Raleigh, NC is $126,672.00, according to ZipRecruiter salary data. Most workers in this role earn between $116,956.00 and $133,387.00 per year, depending on experience, location, and employer.
What jobs pay 2000 a day?
High-paying jobs that can earn $2,000 or more per day include specialized roles such as surgeons, anesthesiologists, corporate lawyers, and senior executives. These positions typically require advanced education, extensive experience, and often involve high levels of responsibility and skill. Freelance consulting, certain sales roles, and project-based work in industries like technology or finance can also reach this earning level for experienced professionals.
What are the key skills and qualifications needed to thrive in the Ncqa position, and why are they important?
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.
How do you become NCQA certified?
To become NCQA certified, organizations must meet specific standards by submitting an application, undergoing a thorough review process, and demonstrating compliance through documentation and evidence. This process often involves preparing for assessments, implementing required practices, and maintaining ongoing compliance to retain certification.
Is NCQA a good place to work?
NCQA offers roles related to healthcare quality measurement and accreditation, often requiring analytical skills and attention to detail. Employees report a professional environment with opportunities for growth, though experiences can vary based on department and role.
What does the NCQA do?
The NCQA (National Committee for Quality Assurance) is an organization that develops standards and measures to evaluate the quality of healthcare organizations and providers. Jobs related to NCQA often involve assessing compliance, data analysis, and quality improvement initiatives within healthcare settings.
What are some common responsibilities for professionals working in NCQA roles within healthcare organizations?
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 is an NCQA job?
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 popular job titles related to Ncqa jobs in Raleigh, NC? For Ncqa jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Ncqa jobs in Raleigh, NC look for? The top searched job categories for Ncqa jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Ncqa jobs? Cities near Raleigh, NC with the most Ncqa job openings:
Full-time
Medical, Retirement, PTO
This job post has expired 1 day ago. Applications are no longer accepted.
AmeriHealth Caritas rating
8.5
Based on 69 frontline employees who took The Breakroom Quiz
87th of 261 rated insurance
Job description
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Role Overview
As the Director Provider Network Management, you will be responsible for all hospital, physician and physician extender network development and management, ensuring the team achieves annual goals and objectives. This position is also responsible for implementing strategies to improve provider satisfaction. In this role, you will collaborate with Hospital and Physician Practice Chief Executive Officers, Chief Financial Officers, Directors of Managed Care and other high level executives.
Work Arrangement
Responsibilities
Education and Experience
Licensure
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
Your career starts now. We're looking for the next generation of health care leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Role Overview
As the Director Provider Network Management, you will be responsible for all hospital, physician and physician extender network development and management, ensuring the team achieves annual goals and objectives. This position is also responsible for implementing strategies to improve provider satisfaction. In this role, you will collaborate with Hospital and Physician Practice Chief Executive Officers, Chief Financial Officers, Directors of Managed Care and other high level executives.
Work Arrangement
- Monday through Friday, 8:30 AM EST to 5:00 PM EST
- Qualified candidates will reside in North Carolina
Responsibilities
- Responsible for strategic planning of hospital and physician network development and management.
- Ensures compliance with pricing guidelines established by AHC and AmeriHealth Caritas North Carolina
- Complies with established contract implementation process(s) for all contracts.
- Ensures department staff remains current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes.
- Ensures provider contracting is consistent with claim payment methodologies.
- Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.
- Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines.
- Ensures provider contracting policies are adhered to as related to standard contract language.
- Ensures that non-standard contract elements are communicated to appropriate departments and obtains AHC and Plan approval prior to submission to provider.
- Responsible for compliance with network adequacy standards.
- Ensures the provider network meets the health care needs of Plan members.
- Establishes a recruitment plan, conducts recruiting activities and oversees the recruitment efforts of staff.
- Augments and modifies the existing provider network to accommodate new products or clients as necessary.
- Ensures provider communication and education meets AHC and Plan needs and functions as the liaison with the designated provider community.
- Leads team in a manner conducive to ongoing growth and expanded knowledge of associates.
- Coach team members in the use of data and appropriate analytical tools that support improved quality.
- Support team members in the identification and creative problem resolution for improved processes and expanded use of technology.
- Systematically keeps staff informed of policy and procedural changes affecting program and administrative operations.
- Resolves individual provider complaints in a timely manner to ensure minimal disruption of the Plan's network.
- Ensures capitation, provider rosters, and RHC/FQHC reports are monitored and strategies are developed and plans are implemented to address outliers.
- Drives Company-wide and Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC.
- Ensures the achievement of financial, quality, and clinical objectives through accomplishment of provider initiatives.
- Responsible for departmental staffing decisions and provides supervision to assigned staff, writes and performs annual reviews and monitors performance issues as they arise.
- Regularly suggests innovative means of structuring operations in a fashion that helps alleviate backlogs and ensures the optimal utilization of resources.
- Coordinates department's efforts with those of other departments.
- Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; works with other departments to develop quality assurance initiatives based on survey results.
- Develops and ensures compliance of department budget.
- Participates in Plan and physician committees as appropriate.
- Performs other related duties and projects as assigned.
- Adheres to AHC policies and procedures.
Education and Experience
- Bachelor's Degree in business or health related disciplines such as Healthcare Administration or Healthcare management or equivalent business experience
- Master's Degree preferred
- Minimum of 3 years Managed Care Provider Contracting and Reimbursement experience, including depth knowledge of reimbursement methodologies and contracting terms
- Minimum of 1 year of Medicaid experience preferred
- Minimum of 8 years of progressive business management and negotiation experience
- Minimum 5 years management experience, managing teams and project management
Licensure
- A valid Driver's License and current Auto Insurance required
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
What AmeriHealth Caritas employees say
Pay
Benefits
Hours and flexibility
Workplace
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About AmeriHealth Caritas
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
5,001 - 10,000 Employees
Headquarters location
Philadelphia, PA, US
Year founded
1983