ncqa jobs in Chicago

About The RoleThe Medical Director performs utilization review and medical necessity determinations for BHPS-administered self-funded commercial plans, and supports the Chief Medical Officer in maintaining the quality, consistency, and defensibility of the department’s clinical decisions. Clinical review is the core of the position; committee, education,...

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 DirectorOptum 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 will find a culture guided by inclusion,...

Senior Account Executive, Credentialing Workforce Solutions (Remote) Azulity | Remote, U.S. | Full-Time $80,000 to $110,000 base + uncapped commission | OTE $150,000 to $190,000 About Azulity At Azulity, we believe healthcare heroes deserve support they can count on. Our experienced credentialing professionals serve health plans, health systems, and...

The Clinical Review Nurse (RN) supports the organization’s care management function by conducting clinical reviews, ensuring appropriate utilization of medical services, and maintaining compliance with regulatory and plan-specific guidelines. This role bridges clinical expertise with administrative processes to promote quality, cost-effective healthcare...

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...

Program Manager, Quality ImprovementWe are an equal opportunity employer. All qualified applicants will receive consideration for employment. We do not discriminate for any reason. We welcome talented individuals who believe in our mission, drive the organization forward, and recognize the positive impact they can bring to our communities.Position SummaryThe...

GENERAL SUMMARY/BASIC PURPOSE OF JOB: The Medical Staff Coordinator reflects the mission, vision, and values of Sinai Health, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. The Medical Staff Coordinator...

Company DescriptionWHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics,...

Overview Chief Operating Officer – SS&C Health role at SS&C Technologies will lead the day-to-day operational functions of the organization, ensuring seamless, efficient, and compliant service delivery across all aspects of the Pharmacy Benefit Administration (PBA) business. This executive position will drive operational excellence that will drive the...

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann &...

Colonial Group is seeking a Program Manager, Quality Improvement to drive patient health outcomes by leading process improvement, analytics, and initiative deployment across IS, Operations, and Medical Services.In this role you will champion CMS/UDS, HEDIS/NCQA and STARS measures, design workflows, collaborate with clinical and operational teams, and guide...

Remote position, however, candidates must reside in the State of TX or State of IL   This position is a contract for about 9 months.   Pay:  $41/hour   RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. This Position Is Responsible For...

Director of Credentialing & Enrollment ServicesDepartment: Credentialing & Enrollment OperationsReports To: Vice President of Operations / Chief Operating Officer FLSA Status:Exempt Location: Remote / HybridBusiness Travel: Required - 0-50% depending on the month---Position SummaryThe Director of Credentialing & Enrollment Services provides strategic and...

Company DescriptionIntegrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has...

Director of Credentialing & Enrollment ServicesDepartment: Credentialing & Enrollment OperationsReports To: Vice President of Operations / Chief Operating Officer FLSA Status:Exempt Location: Remote / HybridBusiness Travel: Required - 0-50% depending on the month---Position SummaryThe Director of Credentialing & Enrollment Services provides strategic and...

  Position Summary The Program Manager, Quality Improvement works to improve patient health outcomes and meet organization wide quality improvement goals. The position is responsible for process improvement, implementing identified quality improvement initiatives and data analytics to support quality improvement initiatives. The position collaborates with...

The role is responsible for management of the Quality and Accreditation Operations department, its products, and deliverables. Responsible for organization strategy for improving the Quality of Care, Customer Service and Resource Use (QCR) measures, incorporating FEP capacity and Plan needs. Serves as resource to BCBSA and Plans in support of primary...

Position SummaryThe Program Manager, Quality Improvement works to improve patient health outcomes and meet organization wide quality improvement goals. The position is responsible for process improvement, implementing identified quality improvement initiatives and data analytics to support quality improvement initiatives. The position collaborates with IS,...

COMPANY OVERVIEW Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the...