ncqa jobs in New York

Sage Dental Management is seeking a Delegated Credentialing Specialist (Remote) to organize, verify, and manage delegated credentialing for General and Specialty Dentists. The role requires adherence to NCQA guidelines, accurate file maintenance, and collaboration with internal departments. Ideal candidates have 2–3 years in healthcare credentialing...

Quality Improvement SpecialistOur organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and...

Humana is seeking a Credentialing Specialist to manage initial and recredentialing for providers, ensuring records are complete and compliant with NCQA, DHS, CMS, and internal policies. The role supports the WI Medicaid Market and collaborates across departments to resolve discrepancies and maintain network integrity. The position is remote with standard CST...

Job DescriptionThe Cardiologist position is based at the Boriken Neighborhood Health Center, a state-of-the-art Federally Qualified Health Center (FQHC) and NCQA-accredited Patient-Centered Medical Home in East Harlem offering comprehensive pediatric and adult primary care, specialty care, and the Boriken Pharmacy. xawqmyg The following information provides...

Transcarent is seeking a Credentialing Coordinator to manage day-to-day provider credentialing and re-credentialing, ensuring NCQA-compliant, audit-ready files. You will verify licenses, board certifications, education, and work history; review applications against requirements; and collaborate across compliance, licensing, and network operations to resolve...

Job DescriptionUnion Community Health Center, Inc. Please read the information in this job post thoroughly to understand exactly what is expected of potential candidates. * * Full Time * Hours: 40 hours per week * Employed * New Graduates * Average Patients seen: 16-20 * Call Schedule: Evening * Loan Repayment * Compensation: - Competitive Base...

DESCRIPTION:Staff will work under the supervision of the HEDIS Coordinator. They are a member of the medical record review team. The team is responsible for obtaining and performing accurate comprehensive reviews of medical records in support of The HEDIS Effectiveness Data and Information Set project. HEDIS reviews are completed in accordance with NCQA...

OverviewSupports interdepartmental Quality Improvement (QI) initiatives focused on promoting high-quality, safe, and equitable member care. Serves as a clinical and operational resource to QI committees, workgroups, and leadership. Analyzes outcomes, HEDIS/CAHPS/Stars performance, and trend data to identify opportunities for improvement in care coordination,...

Summary of Position Provide analysis, reporting, and predictive modeling to support the quality department digital HEDIS strategy under the quality measurement analytics team. Implement automation of manual reporting and analysis of business implications and trends. Automate the intake, use and data governance of clinical and supplemental data sources to...

Reports to VP of Program Operations Job Summary The Manager Credentialing is a hands-on, working manager responsible for the day-to-day credentialing, re-credentialing, licensing, and hospital privileging of all physicians and advanced practice providers contracted with Synergy Health Partners. This role carries an individual credentialing caseload while...

Summary of Position Lead the implementation of the quality department digital HEDIS strategy under the quality measurement analytics team. Lead efforts to continually improve data capabilities and quality of department analysis and reporting. Develop and implement automation of manual reporting and analysis of business implications and trends. Develop,...

Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications. In collaboration with Medical Directors and...

Lead a Manhattan family practice: $230K–$250K, 36 days off, residents to teach and real room to grow! This Jobot Job is hosted by: Nicholas Soares Are you a fit? Easy Apply now by clicking the "Quick Apply" button and sending us your resume. Salary: $230,000 - $260,000 per year A bit about us: We're a nonprofit network of community health centers that has...

HYBRID Remote Full time Bilingual Spanish speaking Physician Assistant with PENSION, 403B Retirement, M-F - NO Weekends!This Jobot Job is hosted by: Donna Gawroski-KusikAre you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume.Salary: $135,000 - $155,000 per yearA bit about us:Highly respected full-service Health Center in...

Team Lead, Clinical Care Review The Team Lead, Clinical Care Review is responsible for providing direct oversight of Clinical Care Review (CCR) employees and overseeing day-to-day workflow within the CCR team.Essential Functions:Provide direct oversight of CCR employees and oversee day-to-day workflow within the CCR teamEnsure all direct reports are...

Summary of PositionManage the daily clinical operation and administration of a Medical Management Department or function to support improved utilization results across the spectrum of medical specialties. Provide clinical leadership both internally and externally. Serve as an essential liaison among Senior Management, Plan staff, contracted providers,...

Lead a Manhattan family practice: $230K–$250K, 36 days off, residents to teach and real room to grow! This Jobot Job is hosted by: Nicholas Soares Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $230,000 - $260,000 per year A Bit About Us We're a nonprofit network of community health centers that has...

If you are a current YAI employee, please click this link to apply through your Workday account. Premier HealthCare (PHC), a member of the YAI Network, is recognized by the US Surgeon General as a national model for the provision of health care, and by the National Council on Disabilities for raising the national standards of health care services for...

AdvantageCare Physicians (ACPNY) is a primary and specialty care practice serving half a million patients across the New York metropolitan area. With more than 30 medical offices across New York City's five boroughs and Long Island, ACPNY is continually expanding our practice and enhancing our services for communities throughout New York. As we grow, our...

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...