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.
Provide timely, high quality clinical recommendations grounded in evidence-based practice.
Communicate assessment findings and provide advice to the in-centre team.
Coach targeted care team members and use technology including Microsoft Teams and electronic resident management systems.
Summerset develops and operates retirement villages across New Zealand, providing care and services that bring the best of life to residents. Their culture is built on teamwork, care, and a drive for excellence, with a strong sense of values.
Lead clinical quality and accreditation readiness for Pelago's care programs.
Run clinical audits and co-lead the Quality and Safety Committee.
Translate Joint Commission requirements into practical guidance and drive improvements.
Pelago is a specialty substance use and mental health care provider that combines technology with clinical expertise to deliver personalized treatment. They partner with employers and health plans and have supported over 750,000 members with substance use care.
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.
Deliver primary care consultations remotely as an Advanced Nurse Practitioner, following clinical governance and national frameworks.
Work evenings and weekends with a minimum of 16 hours per week across four sessions, including a 1-in-4 weekend rotation.
Must be an NMC registered Adult Nurse with an MSc or PGDip in Advanced Clinical Practice and independent prescribing qualification.
Bupa is a health insurer and provider focused on helping people live longer, healthier, happier lives, with customers at the heart of its culture. With over 80,000 employees globally, Bupa champions diversity and supports flexible working, aiming to make health happen for its people.
Lead, coach, and onboard Utilization Management nurses while managing daily workloads and escalations.
Ensure reviews and determinations are timely, accurate, and compliant with CMS and Clover policies.
Collaborate with Medical Directors and cross-functional teams to improve workflows and member outcomes.
Clover Health provides data-driven healthcare plans for seniors, using the Clover Assistant to support physician decisions. The company is a mission-driven team of diverse experts focused on improving members' quality of life.
Manage a patient and provider panel to identify and close HEDIS and Medicare Stars quality gaps through targeted outreach and education.
Partner with nephrology and primary care practices to interpret quality data and implement actionable improvement workflows.
Collaborate cross-functionally with clinical, coding, and pharmacy teams to drive performance, compliance, and patient well-being.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic approach. The company is committed to improving outcomes for patients with kidney disease by providing interdisciplinary resources, analytics, and services.
Develop and oversee quality programs to ensure HIPAA compliance and implement training based on audit trends.
Tune AWS Auto-QA prompts to flag quality and compliance risks while reducing AI hallucination.
Analyze interaction logs via SQL, manage HITL QA workflows, and lead process improvements using Lean/Six Sigma.
Vida is a virtual, personalized obesity care provider that uses evidence-based treatment to help patients manage obesity and related conditions. It is trusted by Fortune 100 companies, major national payers and large providers to enable employees to live their healthiest lives.
Own clinical QA program for all clinicians: audits, workflows, scorecards, Rippit administration.
Implement automation for sampling, screening, flagging, and reporting with validation and trend analysis.
Maintain calibration, onboard new clinicians, and partner with clinical leadership on quality improvements.
Lifeforce is a longevity medicine program providing advanced diagnostics, expert clinicians, and personalized care from home. Founded with leaders from Harvard Medical School and Cleveland Clinic, it has 50+ clinicians and a remote 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.
Conduct moderation activities in line with awarding organisation and regulatory requirements.
Review centre marking to ensure assessment decisions are accurate, consistent and meet required standards.
Produce clear, accurate and timely moderation reports within agreed service level agreements.
We are NCFE, an awarding organisation with a core purpose to promote and advance learning to create a fairer, more inclusive society. With over 170 years of education experience, we are committed to ensuring no learner is left behind and to building rich diversity into our workforce.
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.
Visit providers to carry out moderation in line with quality assurance policies and follow up with remote moderation.
Review centre marking to ensure assessment decisions are accurate, consistent, and meet required standards.
Produce clear, accurate, and timely moderation reports within agreed service level agreements.
NCFE is an educational organisation that promotes and advances learning to create a fairer, more inclusive society. With over 170 years of experience, it offers a collaborative, vibrant, and high-performance culture that embraces everyone.
Conducting external quality assurance reviews and completing accurate reports within agreed SLAs.
Reviewing centre performance, assessment decisions, and quality assurance processes for compliance.
Providing advice, support, and guidance to centres to improve quality and effectiveness.
NCFE is a UK-based educational charity that promotes and advances learning to create a fairer, more inclusive society. With over 170 years of experience, it values diversity, inclusion, and a collaborative, high-performance 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.
Provide strategic and operational leadership for assigned onsite health centers, ensuring alignment with client and organizational goals.
Oversee occupational health services including injury prevention, return-to-work programs, and workers' compensation management.
Mentor nursing leaders and collaborate with interdisciplinary teams to drive clinical quality, compliance, and workforce health outcomes.
Concentra is the nation's leading occupational health care company, with more than 40 years of experience providing employer-sponsored workplace health services. Its culture emphasizes service mentality, attention to detail, and proactive care for America's workforce.
Provide regional clinical leadership and support to ensure safe, high-quality patient care across the North East Region.
Drive quality improvement initiatives, regulatory compliance, and clinical team development.
Partner with clinical, operational, and medical leadership to promote a culture of safety and clinical excellence.
Air Methods is a leading air medical service provider delivering lifesaving care and transport. The company operates multiple bases across the U.S. and emphasizes a culture of safety, accountability, and clinical excellence.
Provide compliance documentation and knowledge management support to the Contracts Management and Compliance Division.
Maintain the organization-wide risk register, track mitigation actions, and support sub-recipient due diligence workflows.
Coordinate compliance training, monitor U.S. government regulatory updates, and prepare compliance reports for leadership.
Jhpiego is a global health nonprofit affiliated with Johns Hopkins University, dedicated to improving the health of women and families in developing countries. The organization values diversity, equity, and inclusion, and offers a supportive, mission-driven work culture.
Performs pre-admission, admission, and continued stay reviews using approved medical necessity criteria.
Coordinates patient care and communicates with physicians, patients, caregivers, and third-party payers.
Manages patient progression through the healthcare system and proactively works with payers to secure certification and minimize denials.
Ochsner Health is a leading not-for-profit healthcare provider in the Gulf South, with 46 hospitals and 370+ care centers. It employs more than 38,000 team members and has been recognized as a top workplace and the No. 1 hospital in Louisiana.
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.