Supervise day-to-day operations of assigned Utilization Management staff.
Provide full people management for assigned Utilization Management teams, including hiring and performance management.
Drive team performance against key metrics, including engagement, productivity, and quality scores.
Personify Health has created a personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together. Their data-driven solutions aim to reduce costs while improving health outcomes, empowering people to lead healthier lives.
Supervise call center staff and provide day-to-day supervision to communicators, implementing performance standards.
Monitor inbound/outbound customer service calls to ensure script adherence, call integrity, compliance, and proper phone technique.
Analyze call metric and productivity reports, share analysis with leadership, and offer recommendations based on analysis.
Inizio Engage is a strategic, commercial, and creative engagement partner that specializes in healthcare. We have a passionate, global workforce of over 7,000 experts in more than 20 countries and an exceptional, collaborative culture.
Own clinical quality strategy for a rapidly scaling network spanning 20+ states, 400+ clinicians, and multiple care models.
Build clinical compliance policy infrastructure that anticipates growth rather than reacts to it.
Lead and develop a team that grows with the organization.
Cartwheel builds a new kind of mental health program for kids that puts schools at the center, supporting school staff. They are an early-stage company backed by top investors and looking for mission-driven teammates.
Review and audit clinical documentation for accuracy, timeliness, and regulatory compliance.
Ensure documentation meets Medicare Conditions of Participation, state regulations, and accreditation standards.
Lead and support Quality Assurance and Performance Improvement initiatives, tracking key clinical and operational indicators.
They are fixing US healthcare by building an AI-native physical care platform, starting with home health. The company is automating administrative work with AI to create a fundamentally different cost structure than incumbents, enabling them to serve more patients.
Serve as primary onboarding liaison and support resource.
Conduct session audits and provide structured clinical coaching.
Evaluate facilitator competency using standardized rubric.
Charlie Health connects the world to life-saving behavioral health treatment, delivering personalized, virtual care. As a rapidly growing organization, it focuses on people with complex needs, expanding access to meaningful care and driving better outcomes from the comfort of home.
Lead, manage, and hold accountable the team of GUIDE Program Coordinators.
Own day-to-day compliance with the CMS GUIDE Model, ensuring eligibility and alignment.
Monitor and operationalize new and updated CMS GUIDE rules into clear workflows.
Ceresti Health provides personalized coaching, care coordination, and care planning to families. They are a quickly scaling company, focused on innovation and supporting caregivers of people living with dementia.
Management and oversight of a quality team conducting quality assurance activities.
Responsible for the successful execution of the Quality Improvement Program in accordance with CMS requirements.
Plans, organizes, and directs activities of Clinical Quality, including planning, training, and staff development.
HealthEdge is committed to workforce diversity and actively encourages all qualified persons to seek employment. They provide effective and efficient solutions to complex business problems.
Lead and inspire a team of Patient Support Specialists.
Establish and refine team KPIs related to outreach volume and scheduling conversions.
Partner with clinical, engagement, and product teams.
Zócalo Health is the first tech-driven provider built specifically for Latinos, by Latinos. They are developing a new approach to care that is designed around shared and lived experiences and brings care to the community. The company was founded in 2021 and is backed by leading healthcare and social impact investors.
Primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements.
Assist with data collection, analysis and reporting for process improvement efforts.
Plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee.
Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health has a supportive, growth-oriented environment and diverse, inclusive teams.
Driving recovery team’s daily productivity, ensuring team is adhering to goals and SLAs.
Effectively collaborating with Management and teams to ensure departmental needs are met.
Machinify is a leading healthcare intelligence company delivering value, transparency, and efficiency to health plan clients. They are deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives.
Own the development and maintenance of clinical and reimbursement policies, ensuring perfect alignment with CMS regulations.
Design and oversee a robust audit program that monitors adjudication system output against clinical policies, pricing, benefit rules, and provider contract terms.
Lead the implementation of AI initiatives to automate the monitoring of reimbursement policies and contract validation.
Clover Health aims to improve the health of its members by leveraging technology and data-driven insights to provide personalized, high-quality care. They are a mission-driven team of individuals, who are passionate about solving healthcare's most complicated problems, and strive to put members first.
Own the full premium audit lifecycle for WC and GL lines of business, ensuring adherence to regulatory requirements.
Lead, coach, and develop a high-performing organization of managers and QA staff.
Enhance the audit customer journey to reduce friction, improve clarity, and increase audit completion rates.
ERGO NEXT's mission is to help entrepreneurs thrive by building the only technology-led, full-stack provider of small business insurance in the industry, taking on the entire value chain and transforming the customer experience. They have helped hundreds of thousands of small business customers across the United States get fast, customized and affordable coverage.
Leads a team of clinicians and serves as a senior clinical owner for care delivery workflows.
Provides clinical support for program development and customer-facing clinical work.
Partners closely with Operations, Product, Member Success, Clinical Outcomes, Legal, Commercial, Customer Success, Solutions Consulting, and Marketing.
Carrot is a global, comprehensive fertility and family care platform, supporting members and their families through many of life's most memorable moments. Its award-winning products serve all populations, from preconception care through pregnancy, IVF, male factor infertility, adoption, gestational carrier care, and menopause.
Support the implementation, monitoring, and reporting of quality improvement activities for a national maternal mental health hotline.
Track program performance, maintain compliance documentation, and contribute to quality reports for federal stakeholders.
Assist in coordinating meetings, developing training materials, and building a culture of continuous quality improvement across a remote team.
Postpartum Support International works to promote awareness, prevention, and treatment of mental health issues related to childbearing. The organization is composed of dedicated and passionate individuals and operates a federally funded national hotline.
Conduct proactive patient outreach initiatives to identify and address quality gaps.
Collect quality data using various methods of data sourcing-EMR, claims, provider outreach.
Communicate quality performances, barriers and improvement strategies both internally and with customers.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.
Design and own the QA program, including frameworks for sampling and audit cadence.
Build structured feedback loops to identify systemic quality issues and remediation opportunities.
Translate QA signals into data-backed narratives to influence prioritization across teams.
Affirm is reinventing credit to make it more honest and friendly, giving consumers the flexibility to buy now and pay later without any hidden fees or compounding interest. Affirm is a remote-first company that offers competitive benefits and focuses on providing a simple and transparent pay structure.
Supervise daily operations to achieve financial and operational goals.
Oversee hiring, training, counseling, and mentoring of property staff.
Review property administrative, accounting, and maintenance compliance.
Highmark Residential values every position and hires people who want to be the best. They provide an empowered, challenging, fulfilling, and financially rewarding workplace.
Lead and manage a team of Credentialing Specialists and Operational Analysts to ensure timely and accurate credentialing file processing.
Oversee credentialing workflows to ensure compliance with NCQA guidelines, state regulatory requirements, and client-specific policies.
Partner with internal stakeholders to resolve escalations, streamline workflows, and improve operational outcomes.
CertifyOS is building the data infrastructure that powers modern healthcare. They value authenticity, accountability, collaboration, results, and openness to feedback, fostering a high-ownership team focused on solving real infrastructure problems.