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 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.
Diagnose ambulatory workflows and shape proposals in discovery and pitches as the operator in the room.
Lead engagements on throughput, space utilization, patient wait times, and scheduling access, including emerging AI capabilities.
Own dedicated consulting engagements, go on-site to document workflows, and present outcomes and expansion opportunities to customers.
Kontakt.io builds real-time operational intelligence for health systems using proprietary hardware, AI, and integrations with existing technology. Backed by Goldman Sachs and trusted by leading health systems, we've more than doubled revenue and are rapidly scaling toward $100M ARR.
Own relationships with commercial and government health plans, serving as primary escalation contact.
Support contract negotiations and renewals with financial analysis, tracking deadlines and rate changes.
Partner with revenue cycle to resolve denials and underpayments, and report payer performance to leadership.
Adaptive Home Health is fixing US healthcare with an AI-native physical care platform, starting with home health. It pairs one of the best AI teams in the world with healthcare veterans, valuing innovation and problem-solving in a fast-growing environment.
Manage day-to-day credentialing workflows and lead data analysis projects for payer enrollment.
Conduct routine audits of task boards and triage inquiries to improve process efficiency.
Develop and distribute reporting on credentialing status for cross-functional stakeholders.
Natera is a global leader in cell-free DNA testing, dedicated to oncology, women's health, and organ health. The company comprises highly dedicated professionals from world-class institutions, who care deeply for their work and each other, fostering a culture that values hard work and growth.
Reviews DRG assignment for Medicare/Medicaid inpatients to ensure compliance with ICD-10 coding and billing regulations.
Analyzes physician documentation for coding accuracy and queries physicians when documentation is inadequate or unclear.
Provides guidance and education to inpatient coders and Clinical Documentation Specialists on coding guidelines.
Hackensack Meridian Health is a health care network that helps patients live better, healthier lives and serves as a leader in transforming healthcare. With a culture rooted in connection and collaboration, their employees are team members supported by competitive benefits and a focus on community.
Oversee credentialing workflows, quality, and compliance standards to ensure provider satisfaction and regulatory adherence.
Develop effective credentialing strategies based on data analysis, regulatory requirements, and operational observations.
Manage credentialing staff, provide coaching and feedback, and drive turnaround time improvement initiatives.
Sutherland is a global digital transformation company combining AI, automation, cloud engineering, and advanced analytics for iconic brands. It creates over 200 inventions and pairs human expertise with AI to unlock performance and deliver measurable results.
Collaborate with health plan leaders to develop quality data strategies and reporting on HEDIS and CAHPS performance.
Oversee data ingestion, validation, and documentation to improve accuracy across EHR, HIE, and supplemental data.
Support regulatory compliance and HEDIS audit readiness while monitoring quality programs and reporting risks.
This organization is a healthcare quality partner focused on national performance initiatives, including HEDIS, CAHPS, and data analytics. It provides a highly collaborative, matrixed environment with opportunities for cross-functional exposure and remote work.
Define and drive the provider experience strategy to help providers build thriving, sustainable practices within the networks.
Lead provider support operations, improving speed, quality, and effectiveness while expanding self-service and AI-enabled support.
Build scalable programs that strengthen provider engagement, retention, and performance across the organization.
Spring Health is a global mental health company on a mission to eliminate every barrier to mental health. The AI-native platform reaches more than 170 million people worldwide through leading employers, health plans, and partners, and the culture values human judgment and AI fluency.