Lead and oversee multiple healthcare audit projects, including PMV and HEDIS activities, from planning through reporting.
Supervise and mentor audit staff, manage budgets and schedules, and serve as a liaison with state Medicaid agencies.
Drive quality improvement, prepare proposals, and present results to clients and stakeholders.
HSAG is a nationally recognized healthcare quality improvement organization specializing in audits, data analysis, measure development, and survey research. The company fosters a supportive culture with work-life balance, flexible schedules, and a commitment to growing staff into future healthcare leaders.
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 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.
Develop and lead the enterprise HEDIS strategy, including measures influencing Medicare Advantage Star Ratings.
Oversee the full HEDIS lifecycle from data acquisition to audit readiness and digital quality measurement.
Build cross-functional improvement initiatives and provider performance strategies to drive quality outcomes.
Capital Blue Cross is a health insurance company and independent licensee of the Blue Cross Blue Shield Association, focused on improving the health and well-being of its members and communities. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."
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.
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 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.
Perform in-depth compliance audits to ensure adherence to local, state, and federal regulatory guidelines.
Identify potential compliance concerns and opportunities for documentation improvement.
Prepare and share detailed audit reports with physicians, advanced practice providers, and clinical leadership.
Baptist Health is a faith-based, not-for-profit health system in Northeast Florida, providing preventive and specialty care through 200+ locations and six hospitals. As the largest healthcare provider in the region, it fosters a welcoming workplace where every team member's voice is heard.
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.
Conduct targeted risk-based audits of high-risk diagnoses and HCCs to ensure clinical documentation supports reported diagnoses.
Deliver peer-level education and feedback to providers to improve documentation accuracy, specificity, and defensibility.
Collaborate with coding, compliance, and clinical leadership to reduce documentation risks and enhance audit readiness.
WellBe Senior Medical provides senior-focused healthcare services with an emphasis on risk adjustment and documentation integrity. The company fosters a remote, collaborative work environment and values compliance, education, and high-quality patient care.
Execute comprehensive desk reviews, auditing documentation and artifacts to verify partner practice maturity.
Analyze high volumes of document submissions with accuracy, transforming subjective evidence into standardized assessments.
Articulate compliance findings and Customer Success principles, including the LAER model, to partners and stakeholders.
Del Oro Consulting is a professional consulting firm that recruits and places specialists for client engagements. The company fosters an equal-opportunity work environment and supports consultants with benefits, though its overall size and culture are not specified.
Audit inpatient DRG, outpatient, and professional fee coding for accuracy and compliance.
Review up to 25 diagnoses and procedures per record, classify errors with references.
Deliver facility audit reports and lead training sessions for coding staff and clinicians.
Arrow ARC provides healthcare staffing and program support to Veterans Health Administration facilities across the U.S. It is a certified Service-Disabled, Veteran-Owned Small Business joint venture known for an agile, mission-focused, results-driven approach.
Oversee healthcare compliance programs covering Medicare billing, HIPAA, FDA regulations, and anti-kickback laws.
Conduct monthly billing audits, regulatory monitoring, and staff training to minimize risk.
Lead breach investigations, manage corrective actions, and collaborate with leadership and legal counsel.
They deliver innovative healthcare technology for remote patient monitoring, emphasizing patient safety and responsible AI use. The culture values compliance, accountability, and cross-functional collaboration among clinical, billing, and operational teams.