Arlington, VA · On-site
$368K - $460K/yr
... 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 ...
Arlington, VA · On-site
$368K - $460K/yr
... 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 ...
$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 ...
$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 ...
... 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 ...
New
... 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 ...
New
... 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 ...
New
... 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 ...
New
Baltimore, MD · Remote
$46 - $51/hr
Follows NCQA Standards and departmental SOPS to manage member assignments. * Conducts research and analysis of behavioral health conditions, ABA treatment methodologies, and emerging practices within ...
Quick apply
Baltimore, MD · Remote
$46 - $51/hr
Follows NCQA Standards and departmental SOPS to manage member assignments. * Conducts research and analysis of behavioral health conditions, ABA treatment methodologies, and emerging practices within ...
... NCQA) accreditations. Knowledge, Skills and Abilities * Knowledge and experience with managing and overseeing the comprehensive assessment, planning, implementation and overall evaluation of ...
... NCQA) accreditations. Knowledge, Skills and Abilities * Knowledge and experience with managing and overseeing the comprehensive assessment, planning, implementation and overall evaluation of ...
Hanover, MD · On-site
$81K - $81K/yr
Training in the Principles of Quality Management and Improvement, NCQA and HEDIS experience preferred. Experience working with multiple clinical and operational functional units and their leadership ...
Hanover, MD · On-site
$81K - $81K/yr
Training in the Principles of Quality Management and Improvement, NCQA and HEDIS experience preferred. Experience working with multiple clinical and operational functional units and their leadership ...
Hanover, MD · On-site
$82K - $82K/yr
Training in the Principles of Quality Management and Improvement, NCQA and HEDIS experience preferred. Experience working with multiple clinical and operational functional units and their leadership ...
Hanover, MD · On-site
$82K - $82K/yr
Training in the Principles of Quality Management and Improvement, NCQA and HEDIS experience preferred. Experience working with multiple clinical and operational functional units and their leadership ...
Baltimore, MD · Hybrid
$19.50 - $25.75/hr
This position directly supports organizational performance related to NCQA accreditation standards, HEDIS quality measures, and CMS requirements through targeted outreach, education, and care ...
Baltimore, MD · Hybrid
$19.50 - $25.75/hr
This position directly supports organizational performance related to NCQA accreditation standards, HEDIS quality measures, and CMS requirements through targeted outreach, education, and care ...
Washington, DC · On-site
$80K - $90K/yr
Experience in principles of Quality Improvement, NCQA Standards, and Accreditation and Certification processes. Benefits: * Affordable Medical, Dental, and Vision insurance. * 401K Retirement Plan ...
Washington, DC · On-site
$80K - $90K/yr
Experience in principles of Quality Improvement, NCQA Standards, and Accreditation and Certification processes. Benefits: * Affordable Medical, Dental, and Vision insurance. * 401K Retirement Plan ...
Gov, National Institute of Health, etc.) Follows NCQA Standards, Medical Policy, all guidelines and departmental SOPS to manage their member assignments. Understands all lines of business to include ...
Gov, National Institute of Health, etc.) Follows NCQA Standards, Medical Policy, all guidelines and departmental SOPS to manage their member assignments. Understands all lines of business to include ...
$80K - $90K/yr
Experience in principles of Quality Improvement, NCQA Standards, and Accreditation and Certification processes. Benefits: * Affordable Medical, Dental, and Vision insurance. * 401K Retirement Plan ...
Quick apply
$80K - $90K/yr
Experience in principles of Quality Improvement, NCQA Standards, and Accreditation and Certification processes. Benefits: * Affordable Medical, Dental, and Vision insurance. * 401K Retirement Plan ...
Fairfax, VA · On-site
$110 - $170/hr
Utilize healthcare industry standards (e.g., CMS, NCQA, HEDIS, Joint Commission) to inform goal‑setting. * Perform comparative analysis across peer organizations and population health metrics.
New
Fairfax, VA · On-site
$110 - $170/hr
Utilize healthcare industry standards (e.g., CMS, NCQA, HEDIS, Joint Commission) to inform goal‑setting. * Perform comparative analysis across peer organizations and population health metrics.
New
Baltimore, MD · On-site
$17 - $22.25/hr
Ensures compliance with agency policies and all applicable federal, state, and regulatory requirements, including HIPAA, HRSA, ADA, OSHA, TJC, and NCQA standards. * Provides andmodelscustomer service ...
Baltimore, MD · On-site
$17 - $22.25/hr
Ensures compliance with agency policies and all applicable federal, state, and regulatory requirements, including HIPAA, HRSA, ADA, OSHA, TJC, and NCQA standards. * Provides andmodelscustomer service ...
Baltimore, MD · On-site
$49K - $53K/yr
Ensures compliance with agency policies and all applicable federal, state, and regulatory requirements, including HIPAA, HRSA, ADA, OSHA, TJC, and NCQA standards. * Provides andmodelscustomer service ...
Quick apply
Baltimore, MD · On-site
$49K - $53K/yr
Ensures compliance with agency policies and all applicable federal, state, and regulatory requirements, including HIPAA, HRSA, ADA, OSHA, TJC, and NCQA standards. * Provides andmodelscustomer service ...
Baltimore, MD · Remote
$51/hr
Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards) * Comfort working in a web-based systems environment and using ...
Quick apply
Baltimore, MD · Remote
$51/hr
Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards) * Comfort working in a web-based systems environment and using ...
Baltimore, MD · Remote
$51/hr
Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards) * Comfort working in a web-based systems environment and using ...
Quick apply
Baltimore, MD · Remote
$51/hr
Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards) * Comfort working in a web-based systems environment and using ...
Baltimore, MD · Remote
$51/hr
Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards) * Comfort working in a web-based systems environment and using ...
Quick apply
Baltimore, MD · Remote
$51/hr
Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards) * Comfort working in a web-based systems environment and using ...
Linthicum Heights, MD · Hybrid
$35.08 - $52.64/hr
Experience in a managed care or care management environment; familiarity with NCQA accreditation standards preferred * Comprehensive knowledge of case management, including assessment, care planning ...
Linthicum Heights, MD · Hybrid
$35.08 - $52.64/hr
Experience in a managed care or care management environment; familiarity with NCQA accreditation standards preferred * Comprehensive knowledge of case management, including assessment, care planning ...
Severn, MD · On-site
$115.08 - $172.62/hr
National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred. * Certified Case Manager preferred. For candidates working in person or virtually in the below ...
Severn, MD · On-site
$115.08 - $172.62/hr
National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred. * Certified Case Manager preferred. For candidates working in person or virtually in the below ...
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.
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.
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.
8.4
Based on 18 frontline employees who took The Breakroom Quiz
67th of 483 rated business services
As a FMD, Radiology 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.
What You Will Be Doing:
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
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.
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 accurate manner.
May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
Participates in on-going training per inter-rater reliability process.
Qualifications:
MD/DO/MBBS
Minimum of five (5) years experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred
Current, unrestricted clinical license in home state medicine or required specialty-
Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs
Active Board Certification by an accredited organization
Strong clinical, management, communication, and organizational skills
Energetic and curious with a passion for quality and value in health care
Computer Proficiency
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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Health care and social assistance
1,001 - 5,000 Employees
Arlington, VA, US
