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Remote Ncqa Jobs (NOW HIRING)

Logix Guru

Medical Director

Our major healthcare client is in need of several physicians to join their team for remote ... The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In ...

BMC HealthNet Plan

Medical Director

Boston, MA · On-site +1

$173K - $250K/yr

Our Investment in You: • Full-time remote work • Competitive salaries • Excellent benefits ... and NCQA requirements • Conducts review of prior authorizations, concurrent reviews and ...

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WellSense Health Plan

Medical Director

MA · On-site +1

$173K - $250K/yr

Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key ... and NCQA requirements · Conducts review of prior authorizations, concurrent reviews and ...

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How much do remote ncqa jobs pay per year?

As of Jul 3, 2026, the average yearly pay for remote ncqa in the United States is $56,684.00, according to ZipRecruiter salary data. Most workers in this role earn between $41,000.00 and $61,000.00 per year, depending on experience, location, and employer.

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.

What are the key skills and qualifications needed to thrive as a Remote NCQA (National Committee for Quality Assurance) professional, and why are they important?

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 remote NCQA jobs?

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 are some common challenges faced by professionals working remotely in NCQA-related 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.
More about Remote Ncqa jobs
What cities are hiring for Remote Ncqa jobs? Cities with the most Remote Ncqa job openings:
What are the most commonly searched types of Ncqa jobs? The most popular types of Ncqa jobs are:
What states have the most Remote Ncqa jobs? States with the most job openings for Remote Ncqa jobs include:
What job categories do people searching Remote Ncqa jobs look for? The top searched job categories for Remote Ncqa jobs are:
Remote Ncqa jobs near you
Infographic showing various Remote Ncqa job openings in the United States as of June 2026, with employment types broken down into 85% Full Time, 5% Part Time, and 10% Contract. Highlights an 100% Remote job distribution, with an average salary of $56,684 per year, or $27.3 per hour.
Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)

Pharmacy CSR Bilingual Spanish (Remote, Must Live in Florida)

Molina Healthcare

Orlando, FL • Remote

$14 - $24.02/hr

Full-time

Posted 3 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

143rd of 277 rated insurance

Job description

Molina Healthcare is hiring a Pharmacy Customer Service Representative. This role is remote for those who live in Florida only.  Bilingual- Spanish speaking is needed.

Our agents assist with all Medicaid member Pharmacy-related calls. You will assist the members with obtaining their medications. This is a pharmacy call center environment focused on first call resolution and the member's experience. 
Pharmacy Reps will be taking calls for the state of FL. Must be bilingual, and live in the state of FL. 
Shift times will be Monday through Friday 8:00a - 4:30p or 10:30a-7:00p EST, all dependent on business needs.
Essential Job Duties

  • Provides customer service support for inbound/outbound pharmacy calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care.
  • Handles and records inbound/outbound pharmacy calls from members, providers and pharmacies in accordance with departmental policies, state regulations, National Committee of Quality Assurance (NCQA) guidelines, and Centers for Medicare and Medicaid Services (CMS) standards.
  • Provides coordination and processing of pharmacy prior authorization requests and/or appeals.
  • Explains point-of-sale claims adjudication, state, NCQA and CMS policies/guidelines, and any other necessary information to providers, members and pharmacies.
  • Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated.
  • Effectively communicates plan benefit information, including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes.
  • Assists members and providers with initiating verbal and written coverage determinations and appeals.
  • Records calls accurately within the pharmacy call tracking system.
  • Maintains established pharmacy call quality and quantity standards.
  • Interacts with appropriate primary care providers to ensure member registry is current and accurate.
  • Supports pharmacists with completion of comprehensive medication reviews (CMRs)through pre-work up to case preparation.
  • Proactively identifies ways to improve pharmacy call center member relations.

Required Qualifications

  • At least 1 year related experience, including call center or customer service experience, or equivalent combination of relevant education and experience.
  • Excellent customer service skills.
  • Ability to work independently when assigned special projects, such as pill box requests, case management referrals, over the counter (OTC) requests, etc.
  • Ability to multi-task applications while speaking with members.
  • Ability to multi-task applications while speaking with members.
  • Ability to develop and maintain positive and effective work relationships with coworkers, clients, members, providers, regulatory agencies, and vendors.
  • Ability to meet established deadlines.
  • Ability to function independently and manage multiple projects.
  • Excellent verbal and written communication skills, including excellent phone etiquette.
  • Microsoft Office suite (including Excel), and applicable software program(s) proficiency.

Preferred Qualifications

  • Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice.
  • Health care industry experience.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Same Posting Description for Internal and External Candidates

Pay Range: $14 - $24.02 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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