• Quality Engineer - NCQA (Mid-Level…

    The Boeing Company (Mesa, AZ)
    …Space & Security** (BDS) is seeking a **Numerical Control Quality Engineer - NCQA (Mid-Level or Senior)** to support the **Air Dominance Proprietary** team in ... **Mesa, Arizona** . **This position may be located on either 1st or 2nd shift and follows a 9/80 working schedule.** **This is at the hiring team's discretion and could potentially change in the future depending on the business needs.** This position will be… more
    The Boeing Company (07/18/25)
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  • Program Manager - NCQA (Hybrid)

    CareFirst (Baltimore, MD)
    …**PURPOSE:** Manages end-to-end oversight of business initiatives. Drives teams and internal projects to maintain and enhance program performance over time. Guides ... stakeholders through key decisions, communicates and coordinates activities internally and across departments. Facilitates process improvement and identifies and articulates stakeholder needs to drive strategies and maximize outcomes related to ROI, customer… more
    CareFirst (07/18/25)
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  • Program Manager, Clinical Compliance

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …and Medical Management's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. This position ... risks to closure, and collaboratively develop mitigation strategies. Other NCQA accreditation work includes delegation oversight and preparing documentation for… more
    Blue Cross Blue Shield of Massachusetts (05/31/25)
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  • UM LVN Delegation Oversight Nurse Remote based…

    Molina Healthcare (Oakland, CA)
    …Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA , CMS and State Medicaid requirements including delegation standards and ... that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the… more
    Molina Healthcare (07/09/25)
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  • Medical Director (CT)

    Molina Healthcare (WI)
    …adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA -compliant ... and quality improvement staff. + Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. + Reviews quality referred issues, focused… more
    Molina Healthcare (07/11/25)
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  • National Manager, Delegation Oversight

    Molina Healthcare (UT)
    …and state delegated activities, ensuring compliance with State, Federal, NCQA and Molina delegation standards and requirements. Provides delegation oversight ... delegation audit assessment tools as necessary to comply with state, federal, NCQA , and any other applicable requirements. + Assists with chairing monthly meetings… more
    Molina Healthcare (07/09/25)
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  • RN Clinical Review Clinician - Appeals

    Centene Corporation (Sacramento, CA)
    …in accordance with policies, guidelines, and National Committee for Quality Assurance ( NCQA ) standards. + Prepares case reviews for Medical Directors by researching ... processing, and response to appeal in accordance with State, Federal and NCQA standards + Communicates with members, providers, facilities, and other departments… more
    Centene Corporation (06/27/25)
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  • Appeals and Grievances Program Advisor

    Commonwealth Care Alliance (Boston, MA)
    …operations and compliance of the Appeals and Grievances department through many NCQA and other related quality program activities including: monthly case quality ... and training and areas on noncompliance. In addition to NCQA program support, this role will also support compliance...Peer calls between requesting MDs and CCA MDs, per NCQA requirements. + Coordinate BOH hearings with external State… more
    Commonwealth Care Alliance (06/06/25)
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  • Sr. Program Manager, Clinical Quality

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …program design and quality improvement initiatives as a consultant for NCQA accreditation standards (including monitoring for identification of risks and improvement ... The role serves as a resource regarding accreditation standards including NCQA standards and continuous quality improvement principles.This role also drives… more
    Blue Cross Blue Shield of Massachusetts (04/30/25)
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  • Senior Clinical Review Nurse - Correspondence

    Centene Corporation (Phoenix, AZ)
    …Reviews outcomes in accordance with National Committee for Quality Assurance ( NCQA ) standards. Works with senior management to identify and implement opportunities ... on denial determinations in accordance with National Committee for Quality Assurance ( NCQA ) standards + Audits and revises correspondence letters to ensure they are… more
    Centene Corporation (07/19/25)
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