ncqa jobs in Chicago

HEDIS Audit Quality Manager (State and NCQA Audits) Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and...

Ann & Robert H. Lurie Children’s Hospital of Chicago is seeking a Credentialing Coordinator Sr to support the Credentialing team in primary source verifications, credentialing and recredentialing for FPP clients, and to ensure NCQA and regulatory compliance. The role requires 2 years of credentialing experience or a BA, CPCS eligibility, and strong data...

Ann & Robert H. Lurie Children’s Hospital of Chicago seeks a Credentialing Specialist to support primary source verification and credentialing processes for managed care providers. The role collaborates with the FPP team, contributes to billing and compliance activities, and ensures timely credentialing for physicians. The ideal candidate has a BA (or 2+...

Ann & Robert H. Lurie Children’s Hospital of Chicago is seeking a Credentialing Coordinator Sr to support the Credentialing team in primary source verifications, credentialing and recredentialing for FPP clients, and to ensure NCQA and regulatory compliance. The role requires 2 years of credentialing experience or a BA, CPCS eligibility, and strong data...

The Credentials Coordinator at UChicago Medicine ensures credentialing for physicians and other eligible medical professionals within the Medical Staff Office, supporting appointments and clinical privileges. Responsibilities include processing applications for appointment and reappointment, verifying licensure and malpractice coverage, and maintaining...

Oscar Health, Inc. seeks an Associate Medical Director, Regulatory Management to lead provider regulatory programs and credentialing within Clinical Affairs. This fully remote role supports members nationwide with enterprise compliance across NCQA, CMS, and state standards. The position requires MD or DO with an unrestricted license, 7+ years of healthcare...

Associate Medical Director, Regulatory Management Remote Hi, we're Oscar. We're hiring an Associate Medical Director, Regulatory Management to join our Clinical Affairs 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...

Associate Medical Director, Regulatory Management Remote Hi, we're Oscar. We're hiring an Associate Medical Director, Regulatory Management to join our Clinical Affairs 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...

Job Position: Clinical Review RNLocation: Chicago, IL 60601Pay Rate: $38.00-39.00/hour based on experienceShift: Monday - Friday 9:30 am CST - 6 pm CSTRequired Experience/Education: Required: Prefer 2-4 years of related experience. Knowledge of Medicare and Medicaid regulations; Knowledge of utilization management. Requires graduated from an accredited...

Associate Medical Director, Regulatory Management Remote Hi, we're Oscar. We're hiring an Associate Medical Director, Regulatory Management to join our Clinical Affairs 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...

Utilization Management Physician ReviewerWe're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At Oak Street Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything...

Utilization Management Physician ReviewerWe're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do....

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Medical Director, Transplantation And Cellular TherapiesOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you...

Medical Director, Transplantation And Cellular TherapiesOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you...

Compensation Over $300,000 potential This role provides physician services including counseling patients regarding the most appropriate setting to meet their healthcare needs, performing diagnostic evaluations and treatment, providing the appropriate information regarding specialist services, and end of life programs. This role functions as a part of a...

Job DescriptionJob DescriptionJob Position: Clinical Review RNLocation: Chicago, IL 60601Pay Rate: $38.00-39.00/hour based on experienceShift: Monday - Friday 9:30 am CST - 6 pm CSTRequired Experience/Education: Required: Prefer 2-4 years of related experience. Knowledge of Medicare and Medicaid regulations; Knowledge of utilization management. Requires...

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something...

This role provides physician services to include patient consultation, primary management of people living with HIV and other chronic infectious diseases. These services include developing a diagnostic and treatment care plan, counseling patients regarding the most appropriate setting to meet their healthcare needs, educating them about their illnesses,...