• Director, Risk Adjustment Prospective Operations…

    Corewell Health (Grand Rapids, MI)
    …ensuring the appropriate metrics are established to ensure productivity and quality outcomes while conducting internal audits for both vendors and providers. ... to meet program goals including but not limited to provider incentive programs, audit and compliance processes and well as EMR optimization and other technology… more
    Corewell Health (07/21/25)
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  • Clinical Operations Leader

    Help at Home (Brooklyn, NY)
    …trainings, CEUs, and licensure renewals for all clinical staff. + Collaborate with Quality and Compliance to support audit readiness, implement corrective action ... individuals and leads a multidisciplinary clinical team to deliver high- quality , cost-effective, and person-centered care in community settings. Key responsibilities… more
    Help at Home (09/03/25)
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  • LVN Phys Pract

    Banner Health (Susanville, CA)
    …another level. Performs audits related to the reimbursement documentation and the quality management process. Reviews audit results and presents summary ... in, general surgeries and orthopedics. **As a Licensed Vocational Nurse , LVN, at Banner Lassen Health Center, you will... and/or licensed physician, and is accountable for the quality of nursing services delivered by self or others… more
    Banner Health (06/29/25)
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  • Human Subject Research Spec I

    University of Rochester (Rochester, NY)
    …to high- quality data collection and analysis, manuscript, grant, and audit preparation in addition to supporting the broader research team through staff ... meeting, and provide updates daily to director, senior specialists and research nurse . **Ensure timely follow-up data collection for the research studies.** +… more
    University of Rochester (08/07/25)
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  • Manager, Prior Authorization RN

    Fallon Health (Worcester, MA)
    …TAT measures + Specialized skill sets + Staff special project completion + Quality audit reviews of authorizations + Updates to Medicare/Medicaid regulatory ... Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top… more
    Fallon Health (08/14/25)
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  • Operations Associate, Part Time, Nights

    Baystate Health (Springfield, MA)
    **Baystate Health, a nationally recognized leader in healthcare quality and safety, is looking for a Part Time Operations Associate to join our team in Springfield, ... Springfield, MA **THE ADVANTAGES OF WORKING WITH BAYSTATE!** + Excellent Compensation High- quality , low-cost medical, dental and vision insurance + Generous PTO - up… more
    Baystate Health (08/26/25)
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  • Revenue Integrity Spec

    Covenant Health Inc. (Knoxville, TN)
    …11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we ... followed per contractual and regulatory guidelines. + Provides education to auditors, nurse and coders in department relative to denials and appeals processes based… more
    Covenant Health Inc. (07/22/25)
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  • Compliance Auditor, Intermediate (Cemc, CPC,…

    UPMC (Pittsburgh, PA)
    …ensure consistency and efficiency in claims processing, data collection, and quality reporting. . **Regulatory Compliance:** Conduct audits on various compliance ... laws, regulations, and policies. . **Reporting:** Prepare written reports of audit results, including recommendations for improvement and compliance with state and… more
    UPMC (09/04/25)
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  • State Director, Health Services

    BrightSpring Health Services (Houston, TX)
    …specific, objectives and responds to negative trends in performance metrics (outcomes, quality audit results, surveys, etc.) by assisting local operations and ... required by delegation standards. Oversees residential operations in achieving the highest quality of health care services for consumers. Supervises the Directors of… more
    BrightSpring Health Services (06/20/25)
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  • RN Manager, Healthcare Services (Nevada Health…

    Molina Healthcare (North Las Vegas, NV)
    …of targeted member population, and triage activities. + Ensures completion of staff quality audit reviews. Evaluates services provided and outcomes achieved and ... HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of… more
    Molina Healthcare (08/13/25)
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