ncqa jobs in Los Angeles

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...

Blue Shield of CA is seeking a Principal Program Manager, Clinical to lead a portfolio of behavioral health strategy and programs. You will collaborate with internal and external partners to advance quality and integrated care across lines of business.Reporting to the Director of Behavioral Health Clinical Market Engagement, Strategy and Programs, you will...

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...

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...

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...

Salary Range: $206,311.00 (Min.) - $278,520.00 (Mid.) - $350,729.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we...

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...

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...

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...

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...

Your Role The Blue Shield Behavioral Health Clinical Market Engagement, Strategy and Programs team works with internal and external business and clinical partners to develop, execute, and evaluate Blue Shield of CA's strategy and ecosystem for behavioral health and addiction medicine. This Principal Program Manager, Clinical role will report to the Director...

Salary Range: $149,502.00 (Min.) - $201,827.00 (Mid.) - $254,152.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make...

Select how often (in days) to receive an alert: Director, Provider Relations and Resolution Management Job Category: Provider Relations Department: Provider Network Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13348 Salary Range:$149,502.00(Min.) -$201,827.00(Mid.) -$254,152.00(Max.) Established in 1997, L.A. Care...

Select how often (in days) to receive an alert: Director, Provider Engagement Job Category: Provider Relations Department: Provider Network Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13347 Salary Range:$149,502.00(Min.) -$201,827.00(Mid.) -$254,152.00(Max.) Established in 1997, L.A. Care Health Plan is an...

Job DescriptionYour Role The Clinical Quality Review (CQR) team investigates and reviews potential quality of care issue(s) (PQI) or concerns arising from member grievances and internal referrals. PQI reviews may confirm a quality problem that resulted in, or had the potential for harm, to the member and can lead to identification of provider opportunities...

Your Role The Clinical Quality Analytics team oversees clinical quality measurement, HEDIS reporting, and related data and audit operations that support quality performance, accreditation, and regulatory requirements. Reporting to the Director of Clinical Quality Analytics, the Senior Program Manager will lead the planning and execution of annual HEDIS audit...

Cope Health Solutions is seeking a full time Advanced Practice Provider (APP)—either a Certified Nurse Practitioner (NP) or Licensed Physician Assistant (PA)—delivers high-quality, autonomous clinical care directly in the homes of Medicare beneficiaries. Reporting directly to the Medical Director, the APP is the clinical backbone of our California-based...

Optum 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, talented peers,...

Your Role The Clinical Quality Analytics team oversees clinical quality measurement, HEDIS reporting, and related data and audit operations that support quality performance, accreditation, and regulatory requirements. Reporting to the Director of Clinical Quality Analytics, the Senior Program Manager will lead the planning and execution of annual HEDIS audit...

Select how often (in days) to receive an alert: Medical Director, Quality Job Category: Clinical Department: Quality Improvement Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13383 Salary Range:$206,311.00(Min.) -$278,520.00(Mid.) -$350,729.00(Max.) Established in 1997, L.A. Care Health Plan is an independent public agency...