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.
1d
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Clinical Quality Consultant
Newton, Massachusetts, United States
$92k-$164k/yr HybridFull Time
5+ YOE5+ years leading quality improvement and data analysis in managed care or provider settings; experience with HEDIS, NCQA, Star Ratings; intermediate Microsoft Office; commitment to health equity.
Microsoft Outlook, Microsoft Word, Microsoft PowerPoint, Microsoft Excel, HEDIS, NCQA, CAHPS, CMS Star Ratings
4w
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Medical Director
Boston or Massachusetts or New Hampshire
$173k-$250k/yr RemoteFull Time
8+ YOEMD/DO with active/unrestricted MA and NH licensure (or ability to obtain), 8+ years related experience (min 5 clinical, min 3 in medical management), board certification, knowledge of InterQual, NCQA, HEDIS, Medicare/Medicaid, strong communication and leadership.
InterQual, NCQA, HEDIS, E-Verify
3mo
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Payer Healthcare Data Scientist, Manager
Boston, Massachusetts, United States
$99k-$232k/yr OnsiteFull Time
6+ YOEBachelor’s degree; 6+ years in data science and ML; leadership experience; healthcare/payer analytics; NCQA HEDIS familiarity; travel up to 80%.
2mo
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Provider Engagement Specialist, Delegated Partnerships
Massachusetts, United States
$72k-$116k/yr RemoteFull Time
5+ YOEBachelor’s in healthcare or equivalent; 5+ years healthcare experience including provider relations/contracting; managed care experience required; NCQA PCMH preferred.
Microsoft Office, Medicaid, Medicare, Value-based program management
2mo
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BH Provider Engagement Specialist III
Boston, Massachusetts, United States
$72k-$116k/yr HybridFull Time
5+ YOEBachelor’s degree in a healthcare field; 5 years healthcare experience incl provider relations/contracting; managed care experience required; NCQA PCMH experience preferred.
Microsoft Outlook, Microsoft Word, Microsoft Excel
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.
1mo
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Credentialing Specialist 40hrs 8am-4:30pm Days
Lawrence, Massachusetts, United States
$24-$37/hr OnsiteFull Time
Associates degree required; CPCS or CPMSM certification preferred. Responsible for primary source verification, new appointment and reappointment processing, and preparation of complete credentialing files in compliance with Joint Commission and NCQA standards.
Echo
1mo
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Credentialing Specialist 40hrs 8am-4:30 Days
Lawrence, Massachusetts, United States
$24-$37/hr HybridFull Time
Associate degree required. Perform primary source verification, prepare appointment/reappointment files, ensure compliance with Joint Commission and NCQA, support meetings and credentialing operations. CPCS or CPMSM and Echo experience preferred.
Echo
1d
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Associate Director, Provider Network Operations & Planning
Boston, Massachusetts, United States
$115k-$145k/yr HybridFull Time
8+ YOEBachelor's required (Master's preferred),8+ years provider network/data/credentialing experience,2+ years with credentialing applications,knowledge of URAC/NCQA and federal program requirements,ability to obtain U.S. government security clearance.
1w
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RN Case Manager
Hingham, Massachusetts, United States
$44-$54/hr OnsiteFull Time
3+ YOEActive MA licensure appropriate to role (RN, LMHC, LICSW, LCSW),3+ years clinical experience, case management experience preferred, knowledge of care management/NCQA standards, strong communication and clinical documentation skills.
1mo
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Provider Enrollment & Credentialing Specialist
Boston, Massachusetts, United States
$18-$32/hr HybridFull Time
2+ YOEHigh school diploma/GED, 2+ years credentialing or payer enrollment experience, intermediate Microsoft Word and Excel, familiarity with NCQA/CMS standards, strong attention to detail, ability to work independently and follow HIPAA privacy rules.
Microsoft Office, Microsoft Excel, Microsoft Word, Resolute, MD Staff
1mo
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BH Medical Director (Per Diem)
Boston or Massachusetts or New Hampshire
$150/hr RemoteContract, Part Time
8+ YOEPhysician (MD/DO) with 8+ years related experience (≥5 years clinical); managed care/medical management experience preferred. Requires active/unrestricted MA and NH physician licensure (or ability to obtain), board certification in psychiatry (Child & Adolescent specialty preferred), and ability to perform clinical utilization and appeals reviews.
InterQual, HEDIS, NCQA, E-Verify