Remote NCQA & CMS Quality Lead

WellSky Corporation; United States; Remote; USD 90,000 - 140,000; Full time

Benefits offered by this job

Excellent medical with Rx, dental, and

Mental Health support through EAP

Generous paid time off, plus 13 paid

100% vested 401(K) retirement plans

Educational assistance up to $2500 per

Job summary

WellSky Corporation seeks a clinical expert to ensure compliance with the Utilization Management and Quality Improvement Program across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities. You will analyze data, present best practices, and drive regulatory alignment with CMS/NCQA standards.

You will lead performance measurement activities, generate audits, and prepare for regulatory and accreditation audits.

Qualifications

• At least 4–6 years of relevant work experience, with leading quality improvement projects.
• Bachelor's Degree or equivalent work experience.
• Active, unrestricted license: RN, PT, OT or SLP preferred.

Responsibilities

• Facilitate performance measurement activities to meet CMS, NCQA standards and regulatory changes.
• Generate and validate reports to monitor performance across health plan contracts.
• Audit UM decisions, case documentation, turnaround times and CMS/NCQA requirements.
• Ensure UM program aligns with NCQA standards for accreditation.
• Lead monthly and quarterly committee meetings per NCQA requirements.
• Prepare detailed quality reports and present actionable recommendations to leadership.
• Support corrective action plans when variances occur and assist quality improvement initiatives.

Skills

Quality improvement

Regulatory compliance

Data analytics

Education

Bachelor's degree

Job description

WellSky Corporation seeks a clinical expert to ensure compliance with the Utilization Management and Quality Improvement Program across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities. You will analyze data, present best practices, and drive regulatory alignment with CMS/NCQA standards.

You will lead performance measurement activities, generate audits, and prepare for regulatory and accreditation audits.