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.
Manage provider data across health plans, including demographics, reimbursement rates, contracts, and key operational information.
Coordinate provider audits, credentialing activities, service and relationship processes, and contract management systems.
Oversee daily priorities for administrative teams and external vendors, using data analysis to improve provider network operations.
This healthcare organization supports provider network operations across health plans. They offer a collaborative, deadline-driven environment with a focus on independent work and analytical skills.
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.
Supports credentialing and enrollment teams by managing data across Monday.com, Airtable, and Credential Stream.
Drives process improvement initiatives and develops progress reports to keep stakeholders informed.
Collaborates with enterprise stakeholders to maintain accurate data sharing and best practices.
United Vein & Vascular Centers is a leading provider of comprehensive vein and vascular care with over 60 clinics across multiple states. The company emphasizes minimally invasive procedures, cutting-edge technology, and a patient-centric approach to deliver superior outcomes.
Manage daily project activities, work plans, and timelines for EQR contracts.
Conduct on-site or virtual compliance reviews of Medicaid managed care health plans.
Support audit reports, technical documents, and communication with stakeholders.
Health Services Advisory Group (HSAG) improves healthcare quality through Medicaid compliance and external quality reviews for state agencies. It is a growing, mission-driven team that values community impact, collaboration, and remote work.
Shape enterprise strategy for provider data quality, governance, and directory accuracy across a nationwide healthcare network.
Lead governance frameworks, auditing programs, and compliance with CMS requirements.
Drive innovation through automation, analytics, and executive stakeholder collaboration.
This role is with a partner company in the healthcare sector, operating a nationwide provider network focused on data quality and governance. The company emphasizes innovation, enterprise-wide transformation, and data-driven decision-making.
Supports and strengthens the Compliance program by providing advisory support to business stakeholders.
Conducts compliance investigations and assists with auditing and monitoring activities.
Advances policy governance and development, translating regulations into practical guidance.
Rula is a mental health company dedicated to providing evidence-based, compassionate care to treat the whole person. They are a remote-first organization with a culture that values diversity, equity, and inclusion, hiring in most U.S. states.
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.
Support day-to-day ACO REACH & LEAD processes, including Zendesk communications and Monday.com solutions.
Generate actionable reports from Medicare data and build decks for performance meetings using Tableau and Snowflake.
Act as a thought partner and advisor for special projects and cross-functional CMMI initiatives.
Aledade PBC empowers independent primary care practices to thrive in value-based care via technology and contracts. Founded in 2014, it is the largest independent primary care network in the US, with a collaborative, inclusive, remote-first culture.
Lead a production-focused pod of Operations Analysts and Credentialing Specialists, owning day-to-day credentialing operations.
Drive team performance by monitoring speed, quality, and efficiency metrics, ensuring SLAs are consistently met.
Coach, mentor, and train team members, conducting daily standups and weekly performance reviews.
CertifyOS builds the data infrastructure for modern healthcare, automating provider licensing, credentialing, and network monitoring. It is backed by leading investors and values authenticity, accountability, collaboration, results, and openness to feedback.
Lead medical information activities for healthcare programs, ensuring high-quality handling of inquiries.
Ensure accurate documentation and triage of medical requests, adverse events, and product complaints.
Manage multiple projects and maintain empathetic customer communication across channels.
The hiring company focuses on delivering medical information and healthcare support programs. It operates with a remote team culture, emphasizing collaboration and professional development.
Lead quality program management activities to ensure compliance with state, federal, and NCQA requirements.
Oversee complex quality deliverables including audits, accreditation surveys, and performance reports.
Collaborate with quality leadership and cross-functional teams to monitor performance and drive continuous improvement.
This organization partners with health plans to implement quality improvement programs and ensure compliance with regulatory standards such as NCQA and HEDIS. The culture emphasizes collaboration, regulatory excellence, and continuous improvement, with a remote work environment for professionals based in Michigan.
Coordinates utilization review and prior authorization requests, ensuring accurate entry into the UM platform.
Provides customer service to providers and members, confirming benefits and answering authorization questions.
Facilitates communication between reviewers, hospitals, and physicians to ensure timely decisions.
University of Utah Health Plans is a patient-focused organization that enhances health through patient care, research, and education. It is part of a nationally ranked academic medical center with five hospitals and eleven clinics, fostering a culture of collaboration and excellence.
Lead advanced compliance activities for healthcare administrative products including HSAs, FSAs, HRAs, and COBRA.
Apply expert regulatory judgment to risk assessments, compliance monitoring, investigations, and corrective actions.
Collaborate with stakeholders to integrate compliance requirements into strategic initiatives and leverage AI-powered tools.
HealthEquity empowers healthcare consumers by providing administrative solutions like HSAs, HRAs, FSAs, and COBRA. The company is a large, mission-driven organization that values inclusion and connects health and wealth for American families.
Analyze high-value and complex claims, ensuring alignment with carrier guidelines and regulatory requirements.
Oversee delegated claims operations and third-party administrators, monitoring compliance and quality.
Provide subject matter expertise and process improvements to strengthen claims governance and outcomes.
They are an insurance organization focused on claims governance, compliance, and operational performance. They are a growing company that prioritizes accountability, service quality, and effective risk management.
Provide non-clinical administrative support for utilization management operations.
Maintain accurate records and documentation across relevant systems.
Collaborate with internal teams to support operational objectives.
They support utilization management operations that help members access appropriate care and services. The company offers a structured, remote work environment with established processes and quality standards.
Lead daily care coordination operations, assign workloads, and manage caseloads to ensure timely service delivery.
Coach and develop team members through mentorship, feedback, performance reviews, and training.
Monitor performance metrics, resolve escalated issues, and collaborate with stakeholders to improve access to care.
A healthcare services organization that helps members navigate care, connect with providers, and manage transitions. It fosters a collaborative, accountable, and member-centered culture with a focus on quality and compliance.
Develop and execute strategic access plans to streamline community access to therapies.
Serve as an in-house reimbursement expert while ensuring compliance with healthcare regulations.
Collaborate with providers, pharmacies, and stakeholders to manage access programs and support community-centered care.
BridgeBio is a biopharmaceutical company that uses a 'moneyball for biotech' model to pool early-stage research and accelerate rare disease treatments. It fosters a culture of curiosity, experimentation, and boundary-pushing, with small expert teams leading the way.
Coordinate administrative activities across professional membership, education, and annual conference initiatives.
Manage scheduling, reporting, and customer service inquiries to ensure program accuracy and responsiveness.
Provide technical coordination for virtual events and support editorial workflows for professional publications.
Provides administrative and coordination support across professional membership, education, and events for healthcare professionals. The company fosters a collaborative, inclusive culture with a mission-driven focus on supporting healthcare professionals.
Manage day-to-day credentialing workflows and lead data analysis projects for payer enrollment.
Conduct routine audits of task boards and triage inquiries to improve process efficiency.
Develop and distribute reporting on credentialing status for cross-functional stakeholders.
Natera is a global leader in cell-free DNA testing, dedicated to oncology, women's health, and organ health. The company comprises highly dedicated professionals from world-class institutions, who care deeply for their work and each other, fostering a culture that values hard work and growth.