NCQA Accreditation Auditor, CVS Health

CVS Health

Location:
United States

Category:
Quality Control

Contract Type:
Employment contract

Salary:

54300.00 - 159120.00 USD / Year

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Job Description:

The NCQA Accreditation Auditor is responsible for evaluating healthcare organizations' compliance with NCQA Accreditation standards and supporting quality activities. This role involves conducting audits, preparing documentation, and collaborating with internal teams, as well as external customers to ensure readiness for NCQA accreditation reviews. The auditor plays a critical role in maintaining quality standards and regulatory compliance across managed care operations.

Job Responsibility:

Lead and support monthly NCQA accreditation audits, pre-delegation evaluations, and readiness assessments
Manage file universe reports and prepare multi-specialty case files (mock and regular)
Assist the Lead NCQA Manager in evaluating organizational policies, procedures, and practices against NCQA standards
Support all accreditation activities, including URAC and NCQA
Prepare and present audit findings and compliance reports to leadership
Collaborate with cross-functional teams to implement process improvement initiatives
Participate in Clinical Committees and support clinical legislative/regulatory reviews to assess NCQA accreditation impact
Manage timelines and deliverables for client audits
Maintain current knowledge of NCQA standards, regulatory requirements, and industry best practices
Support analysis of reporting and quality improvement opportunities
collaborate on action plans and outcomes
Capture data and analytics, develop reports, and work with subject matter experts to ensure ongoing alignment with NCQA requirements and readiness for future accreditation surveys

Requirements:

5–7 years of regulatory and/or clinical audit experience
Experience in medical management, including Utilization Management (UM) and Case Management (CM)
Strong understanding of healthcare quality, accreditation processes, and NCQA standards
Licensed clinical professional (RN preferred)
Excellent analytical, organizational, and communication skills
Proficiency in audit documentation and reporting tools
Ability to work independently and collaboratively in a team environment
Strong problem-solving and decision-making skills
Proven ability to plan, execute, and deliver on complex projects
Bachelor's degree preferred or equivalent experience

Nice to have:

Ability to work independently and collaboratively in a team environment
Strong problem-solving and decision-making skills
Proven ability to plan, execute, and deliver on complex projects

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
November 28, 2025

Expiration:
November 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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NCQA Accreditation Auditor