CQE Manager I-Acupuncture

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a CQE Manager I-Acupuncture in United States.

This role offers a unique opportunity to blend clinical expertise with quality assurance in a fast-evolving healthcare environment. As a key contributor to clinical quality evaluation, you will ensure that acupuncture services meet established medical necessity and evidence-based standards. Working remotely, you will collaborate with cross-functional teams to support quality, compliance, and credentialing initiatives. The position combines independent decision-making with collaborative problem-solving, allowing you to influence care outcomes at scale. Ideal for experienced practitioners, this role emphasizes analytical thinking, clinical integrity, and continuous improvement. You will play a vital part in enhancing care quality while supporting practitioners and healthcare systems nationwide.

• Manage and perform medical necessity reviews for acupuncture services, ensuring alignment with clinical guidelines and best practices
• Conduct timely and consistent evaluations of requests from both network and non-network practitioners
• Communicate clear, evidence-based clinical decisions and rationale to internal stakeholders and peers
• Support credentialing processes, medical record reviews, and quality-of-care investigations as needed
• Contribute to audits, regulatory reviews, and accreditation processes to maintain compliance standards
• Collaborate with cross-functional teams to develop and refine clinical policies, protocols, and quality initiatives
• Participate in workgroups, outreach activities, and continuous improvement efforts to enhance service delivery and clinical outcomes

Requirements:

• Professional degree in Acupuncture from an accredited institution; advanced or specialized training is a plus
• Active, unrestricted license to practice acupuncture in California, with willingness to obtain additional state licenses if required
• Minimum of 5 years of clinical experience, with exposure to medical necessity review or quality evaluation preferred
• Strong understanding of acupuncture guidelines, clinical best practices, and managed care environments
• Excellent analytical and decision-making skills, with the ability to apply evidence-based criteria consistently
• Strong communication and interpersonal skills, with the ability to explain clinical rationale clearly and professionally
• Proficiency with standard business and clinical systems, including Microsoft Office and collaboration tools
• Ability to work independently in a remote setting while maintaining high productivity and attention to detail

Benefits:

• Competitive salary package based on experience and qualifications
• Fully remote work environment with company-provided equipment
• Health, dental, and vision insurance options
• Retirement savings plan and financial wellness support
• Paid time off, holidays, and work-life balance initiatives
• Professional development and continuing education opportunities
• Supportive and collaborative team culture focused on quality and innovation