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Quality Specialist (Hybrid)
Baltimore or Washington
$48k-$96k/yr HybridFull Time
3+ YOEBachelor's degree (or 4 additional years' experience), 3+ years professional experience, expertise with NCQA/HEDIS/CMS frameworks, member/provider engagement, data analysis, and Microsoft Office tools.
NCQA, HEDIS, CMS, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Microsoft Outlook
2w
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Credentialing Supervisor
Fulton, Maryland, United States
$30-$38/hr OnsiteFull Time
3+ YOE3+ years credentialing experience with supervisory exposure; knowledge of NCQA/CMS/payer standards, CAQH, NPI/PECOS, state licenses, DEA, board certifications, and credentialing workflow.
CAQH, Microsoft Office, payer portals, credentialing software
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Principal Architect - Remote or Hybrid in MN and DC
Eden Prairie or Minneapolis or Washington or United States
$135k-$231k/yr RemoteFull Time
5+ YOEUndergraduate degree or equivalent experience, 5+ years in healthcare data architecture, expertise with FHIR/HL7/X12, HEDIS/NCQA quality needs, strong data modeling and cloud platform experience.
FHIR, HL7, X12, CCD/C-CDA, Epic, Cerner, Oracle Health, Snowflake, Databricks, Azure, GCP, dbt, Kafka, CQL
1w
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Quality Improvement Manager
Washington, District of Columbia, United States
$80k-$90k/yr OnsiteFull Time
3+ YOE3+ years quality improvement or behavioral/community health experience; bachelor's degree or equivalent required; master's preferred; experience with accreditation, NCQA standards, auditing; DC clinical licensure (LPC or LICSW) encouraged.
1mo
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Executive Director, Hospital Care Coordination
Washington, District of Columbia, United States
$225k-$281k/yr OnsiteFull Time
10+ YOE10+ Mgmt10+ years of progressive clinical or healthcare management experience; Bachelor's degree in nursing/health services/business/public health; knowledge of Medicare/Medicaid, NCQA, TJC; strong analytics, change management, and communication skills.
1mo
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EEE QI - Credentialing Specialist-New Jersey Ave-DC
Washington, District of Columbia, United States
$60k-$69k/yr OnsiteFull Time
3+ YOEManage credentialing and re-credentialing processes, maintain provider files, perform audits, ensure regulatory compliance (HRSA, NCQA, Joint Commission), verify licensure/certifications; 3+ years credentialing experience; Bachelor's degree or equivalent.
OneApp Pro, CAQH
2w
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Director Case Management
Columbia, Maryland, United States
$121k-$238k/yr OnsiteFull Time
8+ YOE5+ MgmtBachelor's required, Master's preferred. 8+ years managed care experience, 5+ years leadership in case management. Requires RN or LCSW or other licensed clinician eligibility and CCM certification. Experience with Medicaid, CMS, NCQA, risk stratification and data-driven care models.
care management platforms, electronic health records, reporting tools
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Coding Integrity & National Strategy Sr. Principal
Chicago or Washington
$192k-$264k/yr HybridFull Time
10+ YOE10+ years enterprise SaaS sales or business development with 5+ years selling into payer organizations; Bachelor’s required (MBA/MPH preferred); GTM, enterprise sales, payer operations, and compliance experience.
CMS, NCQA, HEDIS, HIPAA, PHI, PII, SOC2, HiTrust
1mo
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Sr Applications Project Specialist- Epic Healthy Planet Certified- Kelsey-Seybold Clinic - Pearland Texas - Remote
Pearland or Minneapolis or Washington or United States
$92k-$164k/yr RemoteFull Time
4+ YOE4+ years systems experience in healthcare or business operations; Epic Healthy Planet certification (or attain within 12 months); strong clinical vocabulary knowledge (LOINC, ICD, CPT); project management, reporting, and stakeholder communication skills; valid Texas driver's license; occasional travel.
Healthy Planet, Epic, Compass Rose, MyPanel, Campaigns, HEDIS, LOINC, ICD, CPT, NCQA