Source Job

• 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.

• 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.

• Directly supervise QA, Grievances & Appeals, and Fraud, Waste & Abuse teams.
• 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.

• 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.

• Manage administrative operations and team members across multiple senior living communities.
• Develop community budgets and business plans to drive census growth and profitability.
• Ensure highest quality resident care and regulatory compliance across all communities.

Monarch develops customized lifestyle options for senior living with a focus on health and wellness. The team is committed to building progressive communities and supporting future generations, though company size is not specified.

• Leverage Medicaid program and policy skills to support clients, including developing 1915(c) waiver amendments and recommendations.
• Build and maintain relationships with clients, stakeholders, and team members while communicating project status.
• Support marketing and business development activities such as writing blog posts and attending conferences.

BerryDunn is a professional services firm that helps businesses, nonprofits, and government agencies solve challenges. Since 1974, the firm has grown to serve clients across the US and its territories, with a people-first culture focused on learning and well-being.

• 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 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.

• Supervise and develop a team of Support Coordinators to ensure high-quality, person-centered service delivery for ECF CHOICES program members.
• Monitor staff performance, ensure compliance with TennCare and BlueCare requirements, and provide coaching and issue resolution.
• Support workforce development through onboarding, mentoring, and continuous education while maintaining regulatory compliance and quality standards.

Volunteer State Health Plan, Inc, part of BlueCross BlueShield of Tennessee, is a health benefit plan company serving Tennesseans since 1945. As the largest health plan in Tennessee, they foster a remote-first culture with a focus on innovation, collaboration, and member well-being.

• Manage day-to-day health plan relationships, program commitments, and client communications.
• Coordinate onboarding and delivery with internal teams, monitor service levels, and resolve issues.
• Lead business reviews with performance insights and maintain alignment between client expectations and deliverables.

This role is with a healthcare services company that partners with health plans to deliver clinical assessments and close care gaps. The company uses AI to review applications and is committed to fairness and transparency in hiring.