Lead and innovate within the Credentialing Department, driving operational excellence and compliance.
Provide strategic direction and oversight to Credentialing Specialists across all lines of business.
Develop and implement policies, procedures, and best practices for efficient and compliant operations.
Avesis has been providing essential ancillary benefit solutions since 1978, developing and administering best-in-class product choices and services. Today, their programs cover more than 8.5 million members throughout the country, striving for excellence with a focus on member satisfaction and client retention.
Ensure adherence to regulations and contractual obligations.
Develop and update compliance policies and SOPs.
Conduct internal compliance audits and report findings.
Equip is a virtual, evidence-based eating disorder treatment program. They aim to ensure that everyone with an eating disorder can access effective treatment, operating in all 50 states and partnered with most major health insurance plans. Since its founding in 2019, Equip has maintained a fully virtual environment.
Performs high-level placement coordination for sites with standard onboarding requirements.
Partners with a Specialist I to ensure learner compliance and site readiness.
Manages operational tasks, focusing on sites that do not require specialized portals or paper applications.
Nightingale Education Group focuses on higher learning in healthcare professions, elevating education, health, and employment systems. It contributes to learners' academic achievement, personal growth, and professional development, serving diverse communities and transforming rural health landscapes through its blended-distance learning platform.
Lead one of Rula’s most critical operational functions.
Own end-to-end credentialing and enrollment outcomes.
Partner across the company to ensure providers are credentialed and enrolled accurately, compliantly, and efficiently.
Rula is dedicated to treating the whole person, not just the symptoms and aim to create a world where mental health is no longer stigmatized or marginalized, but rather is embraced as an integral part of one's overall well-being. Rula is a remote-first company that values diversity, equity, and inclusion.
Manage licensure, certification, and credentialing for all applicable staff.
Track expiration dates and renewal requirements for licenses, certifications, DEA registrations, NPI numbers, and professional credentials.
Ensure compliance with state boards, CMS, accrediting organizations, and payer requirements.
Brighton/Suncrest Hospice aims to redefine hospice care by delivering outstanding service to patients. They achieve this by allocating resources to improve staff-to-patient ratios, increasing clinical visits, and lowering clinician caseloads. They are CHAP certified.
Clinical quality compliance oversight for our clinical development programs both in the US and internationally.
Independently manage domestic and international risk-based audits of investigator sites, study documents, databases, vendors, partners, and internal systems.
Kyverna Therapeutics is a patient-centered, clinical-stage biopharmaceutical company developing cell therapies for patients suffering from autoimmune diseases. Guided by our core values, we are committed to transforming the future of treatment for autoimmune disease.
Oversees daily operations of the Care Management unit and ensures process implementation.
Facilitates staff development, provides regular performance feedback, and identifies areas of improvement.
Evaluates performance metrics, supports staff in care planning, and promotes interdisciplinary collaboration.
Capital Blue Cross promises to go the extra mile for our team and our community. They offer a caring team of supportive colleagues and invest heavily in training and continuing education. Employees consistently vote them one of the “Best Places to Work in PA.”
Oversee full operational execution of the Thera Nurse Navigator Program, ensuring alignment with program goals, compliance standards, and client expectations.
Deliver high‑quality patient education on therapy, disease state, expectations, and adherence support.
Provide coaching, guidance, and ongoing mentorship to Nurse Navigators to ensure adherence to program protocols, SOPs, and quality standards.
EVERSANA is committed to creating and delivering next-generation commercialization services to the life sciences industry, serving more than 650 clients. Their global team of more than 7,000 employees are grounded in their cultural beliefs and dedicated to improving patient lives around the world.
Lead the development, implementation, and continuous improvement of a comprehensive healthcare privacy and compliance program.
Ensure all organizational operations meet and exceed regulatory, governance, and client standards, including HIPAA, HITRUST, SOC2, and Medicare/Medicaid requirements.
Proactively identify and mitigate compliance risks across the enterprise.
EPIC Insurance Brokers & Consultants is one of the fastest-growing firms in the insurance industry. They have over 3,000 employees nationwide and are headquartered in San Francisco. Their core values are: Owner mindset, Inspire trust, Think big, and Drive results.
Responsible for Clinical Chart Validation (CCV) audit operation and talent management.
Oversee process improvement initiatives and the Natural Language Processing program.
Provide supervision and direction to audit Team Leads.
Cotiviti is focused on payment accuracy, helping clients avoid unwarranted payments in the complex healthcare environment. They offer a competitive benefits package and are an equal opportunity employer that values diversity and inclusion.
Own end-to-end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage.
Ensure credentialing policies and documentation meet payer and regulatory requirements.
Build and continuously improve credentialing infrastructure, including SOPs and policies/procedures.
Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the healthcare system. They partner with health plans, providers, and community organizations to deliver culturally competent care; they are scaling rapidly across states and populations.
Stand up and run the daily clinical operations for PIN/CHI delivery.
Define the care team structure, supervision ratios, and operating cadence.
Ensure billing-ready documentation is completed correctly every time. Partner with Compliance + RCM support to prevent leakage/denials caused by ops errors.
Carewell is focused on providing the most trusted and reputable retail source for caregiving products. They have been recognized as one of the fastest-growing companies in the US.