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.
7h
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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
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
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.
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
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.
5d
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Coordinator,Credentialing
Plantation, Florida, United States
HybridFull Time
2+ YOEMinimum 2 years credentialing experience, high school diploma or GED required; associate degree preferred. Knowledge of NCQA, proficiency with Microsoft Word and Excel, SyMed/One App Pro; strong communication and research skills.
Microsoft Word, Microsoft Excel, SyMed/One App Pro
1mo
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Grievance and Appeals Analyst I
Doral, Florida, United States
$22-$24/hr FieldFull Time
2+ YOEMinimum 2 years managed care/appeals or equivalent; working knowledge of Medicare/Medicaid/CMS and NCQA; experience with claims/denial management; strong analytical, written and verbal communication; proficiency with Microsoft Office and case/claims systems.
Microsoft Office
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.