1w
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Appeals & Grievances Quality Auditor
Arkansas or Arizona or Florida or Georgia or Iowa or Illinois or Kansas or Kentucky or Michigan or Minnesota or Missouri or North Dakota or Nebraska or Oklahoma or South Dakota or Tennessee or Texas or Virginia or Wisconsin
$57k-$85k/yr RemoteFull Time
5+ YOEBachelor's degree or equivalent experience and 5 years directly in health plan appeals & grievances; strong audit, analytical, regulatory (CMS/NCQA) and quality improvement skills.
5d
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Credentialing Specialist
Phoenix, Arizona, United States
OnsiteFull Time
2+ YOEMinimum 2 years credentialing/payer enrollment experience in a medical practice, knowledge of CAQH, NPPES/PECOS, NCQA standards, primary source verification, and Microsoft Office.
CAQH, NPPES/PECOS, Microsoft Word, Microsoft Excel, Microsoft Outlook
1w
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Senior Regulatory Implementation and Assurance Analyst
Pennsylvania or Maryland or Washington or North Carolina or Louisiana or Kentucky or Kansas or Indiana or Illinois or Georgia or Iowa or Florida or Colorado or California or Delaware or Connecticut or Arkansas or Arizona or Alabama or Alaska or Nevada or Vermont or Tennessee or Idaho or Oklahoma or Hawaii or Mississippi or Utah or New Hampshire or New Mexico or Wyoming or North Dakota or South Dakota or Rhode Island or West Virginia or Missouri or Texas or District of Columbia or Ohio or New Jersey or Oregon or South Carolina or Virginia or Massachusetts or Nebraska or Minnesota or Michigan or Wisconsin or New York or Maine
$79k-$127k/yr HybridFull Time
5+ YOE5+ years interacting with regulators/auditors, bachelor’s degree or equivalent experience, knowledge of regulatory frameworks (HIPAA, NIST, PCI, CMS, NCQA), strong communication, analytics, and project leadership skills.
3w
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Provider Performance Specialist-Senior
Alabama or Alaska or Arizona or Arkansas or Connecticut or Florida or Georgia or Idaho or Indiana or Iowa or Kansas or Kentucky or Louisiana or Maryland or Michigan or Mississippi or Missouri or Montana or Nebraska or Nevada or New Hampshire or New Mexico or North Carolina or Oklahoma or Rhode Island or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or West Virginia or Wisconsin
RemoteFull Time
4+ YOEBachelor\u0002s or equivalent, 4 years payer/ACO/value-based care experience, advanced Excel and Power BI/Tableau, knowledge of Medicare Advantage/Medicaid/NCQA, strong analytical and communication skills.
Microsoft Excel, Power BI, Tableau
3w
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Sr. Manager Corporate Compliance-Special Needs Plans
Ohio or Irving or Scottsdale or Woonsocket or Hartford or Northbrook
$83k-$183k/yr HybridFull Time
7+ YOE2+ Mgmt7+ years Medicare/Medicaid compliance experience (SNP focus), 2+ years project management, knowledge of CMS/NCQA/regulations, audit and corrective action experience, strong analytical and communication skills, bachelor’s or equivalent.
Microsoft Office, Archer
2w
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Provider Credentialing Rep
Phoenix or Alaska or Arkansas or Arizona or Colorado or Florida or Hawaii or Iowa or Idaho or Illinois or Kansas or Louisiana or Maryland or Minnesota or Missouri or Montana or Nebraska or Nevada or New Mexico or North Carolina or North Dakota or Oklahoma or Oregon or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or District of Columbia or Washington or Wisconsin or Wyoming
$44k-$52k/yr RemoteFull Time
2+ YOEHigh school diploma/GED, 2+ years provider credentialing and provider data system experience, knowledge of URAC/NCQA and federal program requirements, U.S. citizenship and favorable DoD background investigation for TRICARE support.
Outlook, Teams, Word, Excel, PowerPoint, SharePoint
3d
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Clinical Trainer & Auditor - Remote AZ
Arizona, United States
RemoteFull Time
3+ YOEBachelor's in Nursing, active Arizona behavioral health license or RN (NLC within 60 days),3 years clinical care,2 years managed care,NCQA/CMS/AHCCCS and audit experience,training development and delivery skills.
CareRadius
1mo
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Quality Improvement Program Manager - Hybrid
Phoenix or Arizona
HybridFull Time
5+ YOE5+ years healthcare payer/provider experience, Bachelor’s degree required, must reside in Arizona. Experience with NCQA HEDIS and Medicaid managed care, data analysis, reporting, program management, and Microsoft Office. Supervisory experience and ability to travel to stakeholders.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Project, Daptiv, NCQA HEDIS, CMS Core
1mo
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Specialist, Quality
Tucson or Phoenix
OnsiteFull Time
2+ YOEBachelor's in healthcare administration or public health required; 2+ years HEDIS/Risk Adjustment or 4+ years value-based care experience preferred; certifications (CMA, CPT, CNA, or NCQA) OR experience alternatives; EMR and intermediate Microsoft Office skills; bilingual English/Spanish preferred.
Electronic Medical Records (EMR), Microsoft Excel, Microsoft Word, Microsoft PowerPoint
1d
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Manager, Case Management
Alaska or Arizona or Arkansas or California or Colorado or Florida or Georgia or Idaho or Iowa or Kansas or Kentucky or Maine or Michigan or Minnesota or Missouri or Montana or Nevada or New Hampshire or New Mexico or North Carolina or Oklahoma or Oregon or South Carolina or South Dakota or Tennessee or Texas or Utah or Washington or Wisconsin
$89k-$152k/yr RemoteFull Time
5+ YOE3+ Mgmt5+ years case management/healthcare experience, 3+ years management experience, current healthcare licensure, CCM required within 24 months, RN preferred, accreditation and process improvement experience.
NCQA, URAC, LEAN, Synectic