ncqa jobs in Phoenix

CVS Health is hiring a Pharmacy Prior Authorization Technician to support AC and AZ regions. The role involves processing prior authorization requests received by phone, fax, or electronically, researching criteria, and ensuring accurate documentation. Excellent communication and NCQA-compliant language are required. The position is full-time and remote,...

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,...

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,...

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...

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...

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...

Health Services Advisory Group, Inc. (HSAG) seeks a Director, Audits to lead PMV and HEDIS audit activities within the Medicaid Services division. You will supervise the PMV and HEDIS staff, manage project plans, budgets, forecasting, and reporting while coordinating with state Medicaid agencies.The role emphasizes leadership, analytics, and client...

Essential Job Functions And Responsibilities COMPETENCIES Intermediate PC proficiency. Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large...

Summary of Position Manage 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,...

American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Medford, Oregon. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 11/23/2026 Duration: 13 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel Assignment Overview Shift: Days, 5x8hrs Hours: 40 hrs/wk Start Date: Nov...

Integra Partners seeks an LPN/LVN with managed care UM experience to perform pre-service and post-service utilization reviews for DMEPOS. You will collaborate with the Medical Director on benefit and medical necessity decisions within a NCQA-compliant UM program. The role involves applying federal and state mandates, plan benefit language, and criteria such...

Department Name: Work Shift: Day Job Category: Risk, Quality and Safety As an HP LPN Auditor, you will independently triage incoming referrals, manage case assignments, and oversee cases through resolution while ensuring compliance with AHCCCS, Medicare, and Medicaid requirements. This role partners closely with internal teams and external stakeholders to...

Work at HomePart timeJR-916208Your Future Evolves HereEvolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we...