Source Job

Accountable for the management, performance, quality improvement and scalability of our HCP contractor base. Work cross-functionally with Product, Medical Directors, Data, Regulatory, Patient Experience, and Pharmacy teams. Combine people leadership, operational rigour, analytical ownership, and applied AI/automation in a regulated healthcare environment.

Founded in 2019, Felix is a patient-driven digital healthcare company that puts you in control of your health and wellbeing.

• Oversee clinical quality assurance, develop training programs, and ensure regulatory compliance.
• Design, implement, and oversee clinical quality assurance programs for in-home care delivery.
• Design and implement onboarding and continuing education programs for clinical team members.

Sprinter Health is an innovative healthcare startup dedicated to providing high-quality, in-home and virtual care across the country. They employ a multidisciplinary team of clinicians, technologists and operators backed by investors including a16z, General Catalyst, GV, and Accel.

• Supervise a team of approximately 10-15 Lead Care Managers to ensure high-quality care management services.
• Oversee the creation of Individual Care Plans, assessing if clients' needs can be managed by an ECM Lead Care Manager.
• Drive the team to meet key performance indicators (KPIs) effectively.

Vynca is dedicated to transforming care for individuals with complex needs, fostering a close-knit community. They are guided by core values such as Excellence, Compassion, Curiosity, and Integrity, committed to providing comprehensive care for more quality days at home.

• Act as a player/coach, working alongside Care Extenders to build their skills in everyday situations and to directly support members in more challenging situations or as needs arise.
• Build communication strategies to ensure the team is engaging and building relationships with the member cohort in order to support members in reaching their goals.
• Lead our Care Extender team to ensure member needs are assessed adequately and that all members have an appropriate care plan and are making consistent progress toward their goals and graduation from the program.

Mindoula delivers outcomes to our health plan partners through its Interpersonal Violence Reduction Program. Their team of Care Extenders empower members to actively participate in improving their own health and wellness through personalized case management that targets each member’s specific needs.

• Develop standard operating procedures, work instructions, forms, and templates to ensure a fit-for-purpose clinical auditing and inspection management program.
• Develop dynamic, risk-based audit strategy and plan for critical sponsor processes and clinical trials.
• Plan, lead, conduct, document, report, and follow-up of clinical quality audits according to regional compliance regulations, guidance, contracts, and quality agreements.

Praxis Precision Medicines is a clinical-stage biopharmaceutical company translating genetic insights into the development of therapies for central nervous system disorders characterized by neuronal imbalance. Their core Values of Trust, Ownership, Curiosity and Results are foundational to every aspect of their business.

• Manage client crises using evidence-based interventions, providing risk assessment and safety planning.
• Identify roadblocks to clinical care and connect clients to the ideal treatment using Lyra’s proprietary software.
• Independently manage a caseload of complex, multi-need clients.

Lyra Health is the leading provider of mental health solutions for employers, supporting more than 20 million people globally. They have delivered 13 million sessions of mental health care and are known for their AI-powered platform and focus on improving access to high-quality mental healthcare.

• Provide in-the-moment clinical support and connection to appropriate referrals and resources.
• Assess for risks and provide crisis support, safety planning, and follow up with high risk members.
• Recommend a plan of action based on clinical presentation and coordinate connection to appropriate care and services.

Spring Health's mission is to eliminate every barrier to mental health. They partner with over 450 companies, from startups to multinational Fortune 500 corporations, providing care for 10 million people and are valued at $3.3 billion.

Lead a team of Credentialing Specialists and Operational Analysts to ensure efficient credentialing file processing. Provide coaching and training to strengthen credentialing knowledge and regulatory understanding. Monitor contractual Service Level Agreements, turnaround times, and quality metrics; drive corrective actions to maintain compliance.

Certify is on a mission to change how the US healthcare industry deals with provider data, aiming to reduce healthcare costs by streamlining access to this data.

• Lead the development and execution of Care Access’s quality program across clinical, operational, and technology domains.
• Build and maintain a risk-based, fit-for-purpose Quality Management System (QMS) that supports Care Access’s mission.
• Collaborate with Operational Compliance, Product, Privacy, IT, and other functional partners to embed quality by design across systems and workflows.

Care Access is working to make the future of health better for all. With hundreds of research locations, mobile clinics, and clinicians across the globe, they bring world-class research and health services directly to communities that often face barriers to care.

• Directly manage a remote team of Care Partners, providing guidance and support.
• Design and improve operational processes to ensure high clinical quality.
• Monitor key performance indicators to measure success across different teams.

Medsien provides scalable remote care management for a quality patient experience. Hundreds of organizations trust Medsien's technology solutions to implement remote care management programs, personalize every interaction, and improve the lives of the people who need it most.

• Processes acute and post-acute inpatient medical or behavioral health and select intensive outpatient higher level of care requests through review of the submitted request and applicable clinical records
• Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
• Identifies and refers members with complex needs to the appropriate population health and/or care management program.

Capital Blue Cross promises to go the extra mile for our team and our community. Our employees consistently vote us one of the “Best Places to Work in PA, and we foster a flexible environment where your health and wellbeing are prioritized.

• Develop and report key quality metrics across all clinical programs and trials.
• Ensure compliance with GCP, ICH-GCP, FDA, EMA, PMDA, and applicable regulations.
• Drive inspection readiness at local and global levels.

Praxis Precision Medicines is a clinical-stage biopharmaceutical company translating genetic insights into the development of therapies for central nervous system disorders characterized by neuronal imbalance. Their core Values of Trust, Ownership, Curiosity and Results are foundational to every aspect of their business.

• Conduct regular one-on-ones, performance reviews, and development planning.
• Act as the primary escalation point for member issues and complex fertility-related financial and billing issues.
• Use your continuous improvement mindset to define and iterate on processes, making positive enhancements to drive efficiency, value, and accountability toward KPIs.

Maven Clinic is the world's largest virtual clinic for women and families, aiming to make healthcare work for everyone. The company has over 2,000 employers and health plans trusting their platform, and they've won multiple awards for their culture and innovation.

• Lead and develop a team of RN Care Coordinators and non-clinical Care Coordinators.
• Ensure timely progression of members through the surgical review and COE pathways.
• Identify workflow issues and recommend process improvements.

Transcarent and Accolade have come together to create the One Place for Health and Care, the leading personalized health and care experience that delivers unmatched choice, quality, and outcomes. Together, more than 20 million people have access to the combined company’s offerings.

Oversee the operations of the Imagine Pediatrics Onboarding, Credentialing, Licensing, and Enrollment Department. Develop and train on policies and procedures, workflows, and training documentation for the team. Manage Delegated Credentialing arrangements - implementation and audit – as well as ongoing Delegated partnerships with health plans.

Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs.

• Monitor and optimize network adequacy, ensuring geographic and clinical coverage meets member demand.
• Define and track key performance drivers, designing reporting frameworks for real-time visibility.
• Drive cross-functional strategy to bridge network gaps, partnering with Clinical, Product, and Operations teams.

Lyra Health is the leading provider of mental health solutions for employers, supporting more than 20 million people globally. They have delivered 13 million sessions of mental health care and are known for their AI-powered platform and research-backed approach, which improves access, clinical effectiveness, and cost efficiency.