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Remote Ncqa Jobs in Georgia (NOW HIRING)

This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully ... Comprehensive knowledge of NCQA credentialing, CMS standards, and the No Surprises Act. * Prior ...

This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully ... Comprehensive knowledge of NCQA credentialing, CMS standards, and the No Surprises Act. * Prior ...

Remote Ncqa information

What is a remote NCQA job?

Remote NCQA jobs are positions that involve working from home or another remote location to support the standards and accreditation processes of the National Committee for Quality Assurance (NCQA). These roles often include responsibilities such as quality assurance, healthcare compliance, auditing, and documentation review for healthcare organizations. Remote NCQA professionals may work as auditors, consultants, or quality analysts, helping ensure healthcare organizations meet NCQA standards for accreditation. These jobs require knowledge of NCQA guidelines and strong attention to detail, as well as experience in healthcare administration or quality improvement.

What skills and qualifications are needed to thrive as a remote NCQA professional?

To thrive as a Remote NCQA professional, you need a comprehensive understanding of healthcare quality standards, accreditation processes, and regulatory compliance, often supported by experience in healthcare administration or related certifications. Familiarity with NCQA guidelines, quality management software, and electronic health record (EHR) systems is typically required. Strong attention to detail, analytical thinking, and effective communication skills are crucial for success in remote environments. These skills ensure the accurate evaluation and implementation of quality standards, which are vital for maintaining accreditation and improving patient care outcomes.

What are common challenges faced by professionals working remotely in NCQA roles, and how can they be addressed?

Professionals working remotely in NCQA (National Committee for Quality Assurance) roles often face challenges such as coordinating effectively with cross-functional teams, managing detailed documentation, and staying up-to-date with evolving accreditation standards. To address these, it’s important to leverage collaboration tools, establish regular virtual meetings, and maintain organized digital records. Staying engaged with professional development opportunities and NCQA updates can also help remote team members remain effective and compliant.

What is the difference between Remote Ncqa vs Remote Medical Reviewer?

AspectRemote NcqaRemote Medical Reviewer
Required CredentialsMedical license, NCQA certificationMedical license, specialty-specific certifications
Work EnvironmentHome-based, administrative tasks, data reviewHome-based, clinical review of medical records
Industry UsageHealthcare quality organizations, insurance companiesInsurance companies, healthcare providers
Common Search/ComparisonRemote Ncqa vs Remote Medical Reviewer

Remote Ncqa and Remote Medical Reviewer roles both involve healthcare quality and review tasks, often working from home. While both require medical credentials, Remote Ncqa focuses on healthcare quality standards and accreditation, whereas Remote Medical Reviewers primarily evaluate medical records for insurance claims or clinical accuracy. Understanding these differences helps job seekers identify roles aligned with their certifications and career goals.

Is NCQA a good place to work?

Remote NCQA positions are generally considered stable with a focus on healthcare quality standards and data analysis. Employees often work in a collaborative environment, with opportunities for professional development and remote work flexibility. However, experiences can vary based on role and individual expectations.

What are the most commonly searched types of Ncqa jobs in Georgia?

The most popular types of Ncqa jobs in Georgia are:

What cities in Georgia are hiring for Remote Ncqa jobs?

Cities in Georgia with the most Remote Ncqa job openings:

Director, Provider Operations

Oscar Health

Atlanta, GA • Remote

$147K - $193K/yr

Full-time

PTO

Re-posted 28 days ago


Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

258th of 310 rated insurance


Job description

Hi, we're Oscar. We're hiring a Director to join our Provider Operations team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family.

About the role:

The Director, Provider Operations builds, scales and optimizes Oscar's provider data management, contracting, and credentialing processes. This role is responsible for setting the vision and strategy for provider operations and data functions, and designing processes that improve Oscar's capabilities in serving members and providers. The role does this by working with partners and stakeholders cross-functionally to take ideas from vision to implementation.

You will report into the Vice President, Network Operations.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $147,549 - $193,658 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities:

Strategic Leadership & Team Development
  • Provide strategic leadership and operational oversight for the end-to-end provider data lifecycle, ensuring the precise and timely execution of provider credentialing, contract loading, and daily data management.
  • Lead, coach, and develop a high-performing, multi-tiered team of managers and individual contributors; foster a culture of continuous learning, accountability, and psychological safety.
  • Establish clear organizational structure, governance, and support systems that shield the team from distractions and empower them to execute key strategic initiatives.
  • Act as a trusted, collaborative partner to Product, Tech, Markets, and Clinical Operations to design, build, and deliver next-generation provider operations capabilities that support aggressive company growth and market expansion targets.
Operational Excellence & Scalability
  • Architect and implement foundational, industry-standard processes and data models that allow the provider data and contracting infrastructure to scale seamlessly alongside the business.
  • Champion the adoption of industry best practices to ensure all operational processes and internal tools are highly extensible, efficient, and integrated with modern technology stacks.
  • Lead the team in surface-level and deep-dive diagnostics to identify data, process, and technology bottlenecks. Establish robust KPIs and monitoring dashboards to proactively flag operational issues, leveraging these insights to maintain our standing as a leading health plan.
Efficiency, Automation & Compliance
  • Identify and execute opportunities for automation (e.g., RPA, AI integrations) across mature, stable workflows to replace manual intervention, reduce turnaround times, and eliminate human error.
  • Drive administrative expense savings and optimize total cost of care by identifying and executing on process improvements, technical tooling investments, offshore resource optimization, and strategic vendor partnerships.
  • Guarantee 100% compliance with all applicable state and federal laws, regulatory mandates (e.g., No Surprises Act, CMS requirements), and accreditation standards (NCQA).
  • Adapt to evolving business needs by leading critical ad-hoc initiatives and specialized projects as assigned.

Requirements:

  • A bachelor's degree or 5+ years of operating experience
  • 10+ years of work in operations, health insurance, data analysis and/or consulting
  • 5+ years of experience building, coaching and developing operational teams
  • 5+ years experience with network operations, provider data management and contracting processes
  • 5+ years prior successful experience developing and managing large scale initiatives coordinating with internal and external stakeholders
  • 5+ years of experience designing and improving business process for optimization as well as standing up accompanying operating and technical procedures
  • 5+ years of experience using data to influence business decisions
  • 5+ years of experience program management

Bonus points:

  • Proven history of managing high-impact initiatives and pitching complex business cases to secure alignment from executive leadership.
  • Proficiency in SQL, Lean Six Sigma, or other process improvement methodologies
  • Deep understanding of data architecture and optimizing data management workflows
  • Direct experience operating within service-oriented organizational structures
  • Comprehensive knowledge of NCQA credentialing, CMS standards, and the No Surprises Act.
  • Prior success in deploying or refining enterprise-level MDM or Provider Data Management systems.
  • Demonstrated ability to apply AI, RPA, or data analytics to improve roster accuracy and processing speed.
  • Background in leading distributed teams and overseeing external BPO or vendor partnerships.

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