Perform quality audits on clinical documentation across clinical departments.
Collaborate with leadership to develop corrective action plans and provide 1:1 coaching.
Support organizational readiness for NCQA and other regulatory audits.
Oscar is the first health insurance company built around a full stack technology platform, focusing on serving members with a concierge-level experience. It started in 2012 and is an Equal Opportunity Employer cultivating an authentic, inclusive environment.
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.
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 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.
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.
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.
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.
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.
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.
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.
End-to-end credentialing and payer enrollment for multi-state providers across commercial and Medicaid plans.
Vendor governance and SLA performance management to ensure timely provider onboarding.
Delegated credentialing and audit readiness, including NCQA and MCO compliance.
Blackbird Health provides virtual and in-person mental health services for children across Pennsylvania, Virginia, New Jersey, and Maryland, focusing on a whole-child approach that integrates brain, body, and behavior. The company is clinician-founded and owned, with a collaborative, supportive, and innovative team that is expanding into new markets in 2027.
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.
Conduct clinical audits and risk assessments to identify compliance gaps.
Manage multiple client engagements and deliver accurate project results.
Build strong client relationships and present findings to leadership.
Kodiak Solutions transforms healthcare through technology-driven solutions, specializing in finance, unclaimed property, and risk management. Their innovative platform streamlines operations, allowing providers to focus on patient care.
Maintain and update provider information in Provider Data Management systems, ensuring data accuracy and completeness.
Verify provider data from external sources, coordinate with partners to obtain missing information, and resolve discrepancies.
Collaborate with internal teams and support audits to maintain compliance with industry standards and regulations.
Curana Health is a national leader in value-based care, offering solutions to senior living communities and skilled nursing facilities. Founded in 2021, the company has grown to serve over 200,000 seniors in 1,500+ communities across 32 states, with a team of more than 1,000 clinicians and support staff.
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.
Audit participant electronic health records to ensure complete, accurate, and timely documentation.
Identify documentation gaps and collaborate with clinical teams to improve processes and regulatory readiness.
Reconcile regulatory logs and assist with audits and investigations to maintain data integrity.
WelbeHealth is a value-based healthcare organization that provides all-inclusive care to vulnerable seniors, keeping them in their communities. The company emphasizes a supportive team culture with work-life balance and comprehensive benefits.
Provides administrative and project support for quality assurance and program activities.
Coordinates project logistics, documentation, procurement, and compliance processes.
Maintains records, tracks deliverables, and supports audit-ready documentation across workstreams.
This organization is dedicated to international development and quality assurance programs. It fosters a collaborative, mission-driven culture with a focus on inclusion and professional growth.
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.
Evaluate the effectiveness and integrity of insurance operations across a portfolio of specialty insurance partners.
Lead and participate in reviews covering underwriting, documentation, compliance, reporting, and financial activities.
Analyze findings, identify risks, and communicate actionable recommendations to mitigate issues.
Jobgether is a platform that uses AI-powered matching to connect candidates with job opportunities. The company fosters a collaborative, remote-friendly culture and partners with various employers to streamline the hiring process.