1w
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HEDIS Audit Quality Manager (State and NCQA)
Atlanta or Woodland Hills or Waukesha or Hanover or Indianapolis or Miami or Cincinnati or Grand Prairie or Chicago or Iselin or Lake Mary or Woburn or Mendota Heights
$99k-$163k/yr HybridFull Time
3+ YOEBA/BS in a health care field and minimum 3 years healthcare experience plus 3 years QA/QI experience or equivalent; strong knowledge of NCQA HEDIS audit guidelines, audit management, project planning, and data analysis.
5d
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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.
3h
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Director, Credentialing & Enrollment
Plantation, Florida, United States
RemoteFull Time
7+ YOE3+ Mgmt7+ years progressive provider credentialing and payer enrollment experience, 3+ years supervisory experience; knowledge of NCQA/CMS standards, Medicaid/CHIP, and regulatory compliance.
CAQH, PECOS, Credential Stream, MD-Staff
3w
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ROOTS Hub Quality Improvement Specialist (Remote)
North Carolina or South Carolina or Georgia or Tennessee or Virginia or Maryland or Florida
$54k-$70k/yr RemoteFull Time
2+ YOEBachelor's degree and at least 2 years quality assurance/improvement experience; knowledge of QAPI, Medicaid rules, NCQA standards; strong Excel/Word and data analysis skills; excellent communication.
Microsoft Excel, Microsoft Word
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.
2mo
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Senior Health Educator- Asthma Educator - Remote
Miami, Florida, United States
RemoteFull Time
3+ YOE3+ years health education experience; experience with diverse member populations in managed care; ability to build community partnerships; knowledge of HEDIS/NCQA; strong communication skills; MS Office proficiency.
2mo
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Medical Staff Coordinator (Full-Time)
Hialeah, Florida, United States
OnsiteFull Time
1+ YOEMinimum 1–3 years credentialing experience; HS diploma required; healthcare administration degree preferred; knowledge of credentialing databases; familiarity with Joint Commission, CMS, NCQA; proficient in MS Office.
MD-Staff, Echo, Microsoft Office, Credentialing databases
5d
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Quality Accreditation Coordinator
Doral, Florida, United States
$25-$30/hr OnsiteFull Time
2+ YOE2+ years in managed care or health plan setting; HS diploma (or Associate's in healthcare admin, nursing, or related); bilingual English/Spanish; strong data analysis, NCQA knowledge, and Excel skills.
Microsoft Excel
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
5d
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Delegated Network Compliance & Audit Manager | Managed Care & Corporate Development
Gainesville, Florida, United States
OnsiteFull Time
3+ YOEBachelor's degree or equivalent, 3+ years healthcare operations/managed care/credentialing/compliance/audit experience; knowledge of NCQA standards, regulatory requirements, audit readiness, and strong project coordination and communication skills.
1mo
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Market Physician Executive (MPE)
Cape Coral or Fort Myers or Bonita Springs
RemoteFull Time
MD/DO with active, unrestricted state medical license(s); BC/BE in an approved specialty; experience in renal care, geriatrics, population health, NCQA/HEDIS, and clinical leadership; ability to obtain hospital privileges.
Salesforce, Athena
1mo
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Manager of Clinical Care Coordination, DME Respiratory
Miramar, Florida, United States
OnsiteFull Time
3+ YOE2+ MgmtManagerial role requiring 3+ years in utilization/case management (DME/respiratory preferred), 2+ years supervisory experience, expertise in utilization management, medical necessity, CMS/NCQA/URAC compliance, and staff leadership.
1w
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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
5d
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Manager - Quality Care Improvement
Monterey Park or Florida or United States
$105k-$130k/yr RemoteFull Time
5+ YOE2+ MgmtLead regional quality and HEDIS/Medicare Star initiatives; 5+ years quality/HEDIS experience, 2+ years supervisory experience, BA/BS (or equivalent), MS preferred, NCQA expertise, intermediate Excel/PowerPoint skills.
Microsoft Excel, Microsoft PowerPoint
3w
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MEDICAL ASSISTANT (POPULATION HEALTH)
Miami, Florida, United States
OnsiteFull Time
Certified Florida medical assistant with AHA CPR, valid Florida driver’s license, experience with diverse patients and chronic conditions preferred, knowledge of Joint Commission/NCQA/HEDIS/UDS standards, medical terminology, strong computer and communication skills.
2w
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Enterprise Engagement Lead Analyst
Missouri or Florida or California
$88k-$158k/yr RemoteFull Time
5+ YOE5+ years privacy/security/compliance experience, 5+ years analyzing regulatory/contractual requirements, bachelor’s in related field or equivalent, CISSP/CISM/CRISC or privacy certifications preferred, healthcare regulatory framework knowledge.
CMS, HIPAA, NIST 800-53, ISO 27001, CMS/MARSE/ARC-AMPE, NCQA
2d
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HEDIS Utilization Review Nurse
Winter Haven, Florida, United States
OnsiteFull Time
2+ YOERequires Florida nursing license, BLS,2+ years clinical experience, HEDIS/ utilization review or chart abstraction experience preferred, EHR proficiency, strong communication and analytical skills.
EHR, NCQA
2w
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Black Belt Performance Improvement Analyst - Pensacola FL
Pensacola, Florida, United States
OnsiteContract
3+ YOE3+ years as a performance improvement analyst in government (Navy preferred), Master/Black Belt, experience with SPIDR, strong communication, project and requirements management.
SPIDR, ASQ BB Book of Knowledge (BOK), NCQA
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