29 NCQA jobs in United States

Florida, US (Hybrid)

$25.00 – $41.00 / hour

The Administrative Nurse, LPN will support Clinical Review/Utilization Management processes in pre-service medical review, post-service medical…

Johnston, Rhode Island, US (Hybrid)

$100–150K / year

About the Role We are currently seeking a highly motivated Manager, Care Management to support our Health Services Outpatient Care Management team at…

Florida, US (Hybrid)

$25.00 – $41.00 / hour

The Administrative Nurse, LPN will support Clinical Review/Utilization Management processes in pre-service medical review, post-service medical…

United States (Remote)

$34.00 – $61.00 / hour

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals.

United States (Remote)

$34.00 – $61.00 / hour

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals.

United States (Remote)

Welcome! We’re excited you’re considering an opportunity with us!

United States (Remote)

Welcome! We’re excited you’re considering an opportunity with us!

United States (Remote)

$83–132.8K / year

Job Summary: The Manager, Utilization Management is responsible for the oversight of all utilization management activities ensuring consistency of…

United States (Remote)

Category: Health Care Location: Seeking a detail-oriented and highly analytical Registered Nurse (RN) to join our team in a HEDIS Abstraction role,…

United States (Remote)

Overview The Manager, Utilization Review Nursing is responsible for the operational oversight and leadership of Sendero Health Plans’ Utilization…

United States (Remote)

JOB DESCRIPTION Job Summary Provides senior level clinical support to quality team - contributing to quality management programs, initiatives,…

United States (Remote)

This is a remote position.

United States (Remote)

$81.1–157.1K / year

Workforce Classification: Telecommuter Join Our Team: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by…

United States (Remote)

$93.4–132.4K / year

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote!

United States (Remote)

$56.4–90.4K / year

Job Summary: Complex Population Service Determination Specialist II is responsible for processing medical necessity and noncommunity supports and…

United States (Remote)

$35.00 – $40.00 / hour

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw…

United States (Remote)

Position Description Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated…

United States (Remote)

$65–85K / year

Overview HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an…

United States (Remote)

$78–100K / year

Salary based on location: $78,000 - $85,000 if EST or CST; $86,000 - $100,000 if MST or PST.

United States (Remote)

Overview HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an…