Collaborate with health plan leaders to develop quality data strategies and reporting on HEDIS and CAHPS performance.
Oversee data ingestion, validation, and documentation to improve accuracy across EHR, HIE, and supplemental data.
Support regulatory compliance and HEDIS audit readiness while monitoring quality programs and reporting risks.
This organization is a healthcare quality partner focused on national performance initiatives, including HEDIS, CAHPS, and data analytics. It provides a highly collaborative, matrixed environment with opportunities for cross-functional exposure and remote work.
Lead enterprise-wide quality strategy and compliance excellence, driving design, implementation, and continuous improvement of the PACE quality program.
Partner cross-functionally with Analytics, Compliance, and Operations to turn complex data into actionable insights and elevate quality.
Oversee Quality Operations teams, regulatory reporting, and corrective action plans to ensure participant safety and readiness.
WelbeHealth serves communities' most vulnerable seniors through PACE programs, focusing on participant-centered care. The company values pioneering spirit and offers a collaborative culture with comprehensive benefits and a commitment to diversity and inclusion.
Conduct quality audits and validate provider data to ensure accuracy, integrity, and compliance with regulatory standards.
Analyze trends, investigate discrepancies, and recommend corrective actions to strengthen provider network operations.
Collaborate with cross-functional teams to document evidence, support accreditation reviews, and drive continuous improvement.
Alliance Health is a managed care organization that coordinates services for individuals with complex needs in North Carolina. They foster a collaborative, mission-driven culture focused on quality, compliance, and remote work flexibility.
Manage a patient and provider panel to identify and close HEDIS and Medicare Stars quality gaps through targeted outreach and education.
Partner with nephrology and primary care practices to interpret quality data and implement actionable improvement workflows.
Collaborate cross-functionally with clinical, coding, and pharmacy teams to drive performance, compliance, and patient well-being.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic approach. The company is committed to improving outcomes for patients with kidney disease by providing interdisciplinary resources, analytics, and services.
Own quality performance across all clinical tiers, including call and documentation quality for RNs, providers, and PSS Engagers, plus organization-wide clinical outcomes.
Lead and develop a team of Quality Reviewers, setting standards, conducting calibrations, and coaching to ensure consistent, defensible scoring.
Build and analyze quality dashboards and datasets to identify trends, root causes, and improvement opportunities, presenting findings to executive leadership.
CareTalk Health is a fully remote, nationwide virtual medical practice partnering with Medicare Advantage plans to deliver Annual Wellness Visits and close care gaps. We are a growing, collaborative team focused on making virtual care simple, reliable, and human.
Interpret federal and state regulations to ensure compliance and drive process improvements.
Analyze data in Excel to identify trends, savings, and process improvements.
SIHO Insurance Services provides health insurance administration and related services, focusing on payment integrity and regulatory compliance. The company operates in a managed care environment and emphasizes collaboration, professionalism, and adaptability among its employees.
Lead the strategy and execution of provider-facing risk adjustment initiatives.
Partner with teams like Network, Data Science, and external providers for cross-functional program delivery.
Analyze provider performance to identify opportunities and develop improvement plans.
Oscar is a health insurance company built around a full-stack technology platform focused on serving its members. Founded in 2012, Oscar is a sizable organization that fosters a culture of authenticity and belonging.
Serve as the primary resource for quality assurance initiatives for the Family Heritage Division.
Develop and maintain systems, dashboards, and reports to make quality data actionable.
Monitor key performance indicators and investigate agent misconduct to ensure regulatory compliance.
Globe Life is an insurance company committed to empowering employees and fostering a caring, innovative culture. The company values collaboration, respect, and growth, helping employees make tomorrow better.
Oversee CMS and state audit readiness, live audit management, and corrective action plans.
Build internal monitoring, training, and reporting to foster a culture of compliance.
Collaborate with clinical and operations teams to integrate audit findings into improvements.
Habitat Health empowers older adults to experience more good days through the Program of All-Inclusive Care for the Elderly (PACE), delivering coordinated medical and social care in homes and communities. Supported by leading healthcare organizations and investors, the company is expanding its scalable model with a mission-driven culture focused on participant well-being.
Oversee delegated audits related to UM, Credentialing, Claims, Enrollment, and Appeals processes to ensure compliance with payer contracts.
Educate staff, update policies and workflows, and act as a liaison between payers and local market leadership during audits.
Operationalize regulatory communications from governing bodies and document process changes for upstream and downstream teams.
Dignity Health Management Services offers integrated management and business services to healthcare providers, focusing on managed care administrative and clinical services to contain costs and improve quality. It is part of CommonSpirit Health, a large health system with a mission-driven culture centered on community and patient care.
Lead end-to-end onboarding for commercial sites, ensuring alignment with quality standards.
Coordinate with internal teams to ensure seamless transitions and monitor progress.
Conduct site assessments, provide training, and drive continuous improvement.
Orca Bio is a commercial-stage biotechnology company developing high-precision cell therapies to treat blood cancer and redefine the transplant process. It maintains a start-up culture of camaraderie, passion, and integrity, with a mission to make treatments accessible to all who need them.
Lead clinical quality and accreditation readiness for Pelago's care programs.
Run clinical audits and co-lead the Quality and Safety Committee.
Translate Joint Commission requirements into practical guidance and drive improvements.
Pelago is a specialty substance use and mental health care provider that combines technology with clinical expertise to deliver personalized treatment. They partner with employers and health plans and have supported over 750,000 members with substance use care.
Ensure the Enrollment Team delivers high-quality, compassionate interactions with prospective members through call audits and evaluation reviews.
Lead calibration sessions and identify trends, opportunities, and improvements for QA rubrics and processes.
Use data and AI technology to surface insights, optimize quality platforms, and advance strategic quality initiatives.
Thyme Care is a market-leading value-based oncology care enabler that partners with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for people with cancer. They are a tech-native organization with a culture centered on human connection, innovation, and continuous improvement, serving thousands of patients across the country.
Own and continuously improve the Quality Management System for simulation products, programs, and services.
Serve as the primary quality liaison for customers, suppliers, and subcontractors, ensuring requirements flow down and are met.
Drive risk-based audits, CAPA activities, and root-cause analysis to improve quality performance and compliance.
Aechelon Technology, a Shield AI company, produces 3D simulator content including geospecific visual/sensor databases and realistic 3D models for pilot training. The company seeks passionate people committed to real-time computer graphics and the mission of improving pilot safety.
Lead multiple Team Leads overseeing credentialing operations, ensuring efficiency, accuracy, and compliance.
Own client health KPIs, drive performance metrics, and resolve escalations to ensure SLAs are met.
Partner with internal teams to optimize workflows, implement process improvements, and ensure business continuity.
CertifyOS builds the data infrastructure that powers modern healthcare by automating provider licensing and credentialing. Backed by leading investors, they have a high-ownership team focused on solving real infrastructure problems for millions of patients.
Lead external customer audits and utilization management oversight activities as a subject matter expert.
Analyze complex UM data, investigate findings, and prepare evidence-based responses for regulators and accreditation organizations.
Collaborate with operational, technical, and client-facing teams to drive compliance and process improvements.
This company is a healthcare organization specializing in utilization management and regulatory compliance. It operates with a remote team across the United States, fostering a collaborative and improvement-driven culture.
Lead enterprise compliance program execution, including strategy, risk assessments, and policy governance.
Oversee compliance investigations, monitoring, auditing, and regulatory change management.
Provide guidance on federal and state healthcare regulations and emerging risks, partnering with senior leaders.
Oscar is a health insurance company built on a full-stack technology platform, focused on serving members. We started in 2012 and foster a culture of authenticity and belonging, with a mission to change healthcare.