Leads claims quality assurance strategy and execution to ensure accurate, timely payments and compliance with Medicare, Medicaid, and regulatory requirements.
Drives continuous improvement through data-driven auditing, trend analysis, and cross-functional collaboration.
Directly supervises team members, evaluates performance, and identifies training gaps to strengthen workflows.
Lead quality assurance, training, and professional development initiatives for medical management teams.
Design and maintain onboarding programs, continuing education, and audit calibration processes.
Analyze operational metrics and audit results to drive process improvements and enhance member support.
This partner company specializes in medical management and healthcare operations, providing quality assurance and professional development for client organizations. It operates as a remote-first organization with a culture focused on employee support, continuous improvement, and cross-functional collaboration.
Lead and oversee multiple healthcare audit projects, including PMV and HEDIS activities, from planning through reporting.
Supervise and mentor audit staff, manage budgets and schedules, and serve as a liaison with state Medicaid agencies.
Drive quality improvement, prepare proposals, and present results to clients and stakeholders.
HSAG is a nationally recognized healthcare quality improvement organization specializing in audits, data analysis, measure development, and survey research. The company fosters a supportive culture with work-life balance, flexible schedules, and a commitment to growing staff into future healthcare leaders.
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.
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.
Lead premium audit strategy and operations to ensure regulatory compliance and financial integrity.
Oversee audit quality, data integrity, and implementation of business-wide improvements.
Manage budgets, workforce planning, vendor relationships, and team development.
The company is an insurance organization specializing in workers' compensation premium audit operations. It fosters a collaborative work environment with a focus on integrity, customer service, accountability, innovation, and employee fulfillment.
Lead strategic and operational oversight for Medicaid external quality review contracts, ensuring compliance, quality, and timely deliverables.
Serve as the senior relationship manager for state Medicaid agencies and stakeholders, proactively resolving concerns and driving customer satisfaction.
Direct project planning, budgets, staffing, and team development while identifying risks and supporting business development initiatives.
Health Services Advisory Group (HSAG) is a national healthcare quality consulting organization that partners with states to improve healthcare delivery through external quality reviews and data-driven solutions. The company fosters a mission-driven, collaborative culture dedicated to making healthcare better for communities and clients.
Analyze high-value and complex claims, ensuring alignment with carrier guidelines and regulatory requirements.
Oversee delegated claims operations and third-party administrators, monitoring compliance and quality.
Provide subject matter expertise and process improvements to strengthen claims governance and outcomes.
They are an insurance organization focused on claims governance, compliance, and operational performance. They are a growing company that prioritizes accountability, service quality, and effective risk management.
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 a remote team of clinical auditors performing medical record review with primary oversight of Skilled Nursing Facility (SNF) audits.
Serve as the primary subject matter authority for SNF audit programs, including Medicare Part A coverage, PDPM, and MDS 3.0.
Manage team performance, conduct reviews, and drive continuous improvement in audit accuracy and efficiency.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company combines a configurable AI-powered platform with best-in-class expertise to drive down healthcare costs.
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 daily care coordination operations, assign workloads, and manage caseloads to ensure timely service delivery.
Coach and develop team members through mentorship, feedback, performance reviews, and training.
Monitor performance metrics, resolve escalated issues, and collaborate with stakeholders to improve access to care.
A healthcare services organization that helps members navigate care, connect with providers, and manage transitions. It fosters a collaborative, accountable, and member-centered culture with a focus on quality and compliance.
Lead and manage the coding team, setting productivity and quality standards for documentation and coding operations.
Oversee pre-encounter review workflows, query auditing, and vendor performance to drive compliance and risk adjustment outcomes.
Collaborate with clinical, operations, compliance, and finance stakeholders on program objectives and process improvements.
WellBe Senior Medical provides healthcare services focused on seniors, with an emphasis on documentation accuracy, coding compliance, and risk adjustment. The company operates in a remote, cross-functional environment and values compliance, quality, and continuous improvement.
Maintain compliance policies, annual reviews, and state-specific scope-of-practice requirements.
Deliver compliance training, administer the hotline, and conduct investigations.
Execute audit and monitoring plans, support payer audits, and coordinate corrective actions.
Herself Health provides primary care designed for women 65 and older, focusing on post-menopausal care, bone health, and mental well-being. It is a growing organization with a collaborative, patient-first culture that values curiosity, ownership, and teamwork.
Own end-to-end NCQA Utilization Management reporting across Medicaid markets.
Collaborate with clinical, operational, and compliance teams to ensure accurate, timely deliverables.
Support governance committees, corrective actions, and accreditation activities.
Healthcare operations company specializing in Medicaid utilization management, regulatory compliance, and policy governance. It operates across multiple markets with a collaborative, multidisciplinary team culture.
Oversee daily operations for waiver and state-funded programs supporting individuals with intellectual and developmental disabilities.
Lead and develop multidisciplinary teams, ensuring regulatory compliance, quality care, and effective service delivery.
Manage administrative processes, quality assurance, and community outreach to support organizational growth.
Jobgether is an AI-powered job matching platform that connects candidates with hiring organizations. It uses objective, data-driven processes to help companies find top-fitting candidates.
Lead and support daily team operations, providing coaching, guidance, and professional development to team members.
Manage workflows, staffing, and performance to ensure service levels, KPIs, and quality standards are consistently met.
Coordinate training and process improvements while handling escalated customer issues with empathy and sound judgment.
Our partner provides insurance operations and customer-focused services across the United States. The company fosters a collaborative, inclusive culture centered on continuous improvement, employee development, and integrity.
Provide leadership and coaching to Accounts Receivable Specialists, focusing on performance, accountability, and continuous improvement.
Analyze AR trends, develop KPIs, and execute strategies to improve collections and reduce aging.
Collaborate cross-functionally with revenue cycle, compliance, and operations teams to resolve complex payer issues.
Helping Hands Family is a top-rated provider of applied behavior analysis (ABA) therapy for children. They are a Great Place to Work Certified company with a supportive and inclusive culture.
Leads enterprise authorization operations with direct impact on revenue protection, patient access, and reimbursement performance.
Manages a team responsible for insurance verification, pre-authorization, and timely processing of assigned services.
Collaborates with billing, registration, revenue cycle, clinical, and administrative teams to reduce preventable payment denials.
The partner company is a healthcare organization focused on revenue protection, patient access, and reimbursement performance. They provide a collaborative and mission-driven environment for teams working across complex healthcare operations.
Lead and support the User Support team to ensure timely, accurate resolution of user issues and consistently exceed service standards.
Monitor workflow via phone, email, and action lists, while providing resolution for escalated calls and acting as a liaison across internal teams.
Assist management with employee performance, training, and corrective actions while maintaining broad knowledge of HIPAA regulations and ROI processes.
MRO provides release-of-information (ROI) services, helping healthcare organizations manage medical record requests and maintain compliance. The company promotes a team-oriented culture focused on service excellence, quality assurance, and professional development.
Shape enterprise strategy for provider data quality, governance, and directory accuracy across a nationwide healthcare network.
Lead governance frameworks, auditing programs, and compliance with CMS requirements.
Drive innovation through automation, analytics, and executive stakeholder collaboration.
This role is with a partner company in the healthcare sector, operating a nationwide provider network focused on data quality and governance. The company emphasizes innovation, enterprise-wide transformation, and data-driven decision-making.