• Manager of Care Management

    WellSense (Manchester, NH)
    …implementation of policies and procedures that integrate state, federal and national accreditation regulations to ensure compliance. The manager will oversee the ... Manager of Care Management WellSense Health Plan is...consistent with current federal and state regulations and applicable accreditation standards (eg NCQA ) + Works closely… more
    WellSense (08/22/25)
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  • Clinical Care Manager

    WellSense (Manchester, NH)
    …and in keeping with contractual requirements, internal policy and NCQA accreditation standards.Facilitates multidisciplinary consultation on members' behalf ... Clinical Care Manager WellSense Health Plan is a nonprofit health...or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly… more
    WellSense (08/22/25)
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  • Manager , CIC Advanced Practice Clinician…

    Commonwealth Care Alliance (Boston, MA)
    …development experience + Value-based contracting familiarity + Education/Training experience + NCQA Accreditation Experience + Healthcare Quality Measures EEO is ... that require intensive care management and care delivery. Within the CIC Program , the Manager , Clinical APC is responsible for the oversight of clinical care… more
    Commonwealth Care Alliance (08/19/25)
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  • Associate Manager , Clinical Health…

    CVS Health (Little Rock, AR)
    …+ Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (eg, NCQA , URAC, state and federal standards and ... that promote high-quality healthcare for members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This… more
    CVS Health (09/08/25)
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  • Associate Manager , Clinical Health…

    CVS Health (Little Rock, AR)
    …+ Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (eg, NCQA , URAC, state and federal standards and ... that promote high-quality healthcare for members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This… more
    CVS Health (08/30/25)
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  • Senior Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …cohesive collaboration necessary for the continuum of care foundation for our NCQA required population health management program . Additionally, this position ... needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'...+ Plans, organizes, and directs the professional medical services program , consisting of all primary and specialty services for… more
    Sharp HealthCare (07/19/25)
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  • Manager , Business Compliance

    CVS Health (Richmond, VA)
    …management, case management, disease management. + Experience with URAC and NCQA accreditation requirements + Experience collaborating with legal counsel ... + Supports the implementation and maintenance of an effective Compliance program supporting First Health, Aetna Signature Administrators, and American Health… more
    CVS Health (09/05/25)
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  • Supv Regional Care Mgmt- Integrated Care Mgmt…

    Sharp HealthCare (San Diego, CA)
    …**What You Will Do** Manage an effective in-patient Care Management program that includes initial and concurrent review; case management/discharge planning ... plans related to health plan audits and requirements of NCQA . Collaborates with the Quality, Compliance and Training Department...and implements new programs under the direction of the manager of in-patient care management and the Director of… more
    Sharp HealthCare (07/09/25)
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  • Director, Quality

    Somatus (Mclean, VA)
    …strategy in a fast-paced, evolving environment + Familiarity with CMS programs and NCQA accreditation survey experience, including submission of documents to ... responsible for establishing, implementing, and overseeing an effective quality improvement program essential to meet NCQA requirements, state specific… more
    Somatus (08/12/25)
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  • Medical Director - Sharp Health Plan - Hybrid…

    Sharp HealthCare (San Diego, CA)
    …for implementing the Utilization/Cost Management Program and Quality Improvement Program , in conjunction with the Manager Medical Management and Quality ... care needs of the membership. Serves as a medical manager and policy advisor to SHP and its Chief...plan Chief Medical Officer) in short and long range program planning, total quality management (quality improvement), and external… more
    Sharp HealthCare (08/17/25)
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