- Clever Care Health Plan (Huntington Beach, CA)
- …that all aspects of the provider and facility credentialing and re- credentialing lifecycle meet CMS, NCQA, and internal quality standards. In addition, ... in audit preparation and corrective action plans relating to credentialing functions. Ensure all providers and facilities in the network meet regulatory… more
- Insight Global (New York, NY)
- Job Description Responsibilities: Perform detailed quality audits on credentialing files to ensure compliance with NCQA, TJC, and organizational standards. ... and timeliness of all credentialing data. Ensure credentialing files meet internal SLAs and quality ... and/or payer enrollment experience, with demonstrated exposure to audit or quality review processes. Strong understanding… more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …your success. This position has dually aligned responsibilities, while striving for excellent quality of patient care; 1). Payer Credentialing initial and re- ... requirements of delegated agreements, creating file review rosters, file review audit (electronically), coordinating quality reporting, reviewing findings and… more
- Veterans Affairs, Veterans Health Administration (Roseburg, OR)
- Summary The Health System Specialist - Credentialing and Privileging Specialist is assigned to the Medical Staff Office, which is under the Chief of Staff at the ... responsible for providing administrative and technical direction and support to the credentialing and privileging (C&P) operations. The C&P Specialist is aligned to… more
- Magellan Health Services (Boise, ID)
- …and other metrics. + Supervises care management staff through approved audit processes including performing annual reviews and provides counseling and disciplinary ... action as necessary. + Coordinates quality improvement activities under the direction of clinical management. + Assists management in the development of strategic… more
- Molina Healthcare (TX)
- …and accuracy in a timely manner to meet department standards of turnaround time and quality . + Audit loaded provider records for quality and financial ... customers as it pertains to contracting, network management and credentialing . **KNOWLEDGE/SKILLS/ABILITIES** + Receives information from outside party(ies) for… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Health Plan Quality Assurance Specialist - RN Location: Remote Career Area: Health ... quality investigations, including connections with other departments (contracting, credentialing , medical management, etc.). * Draft and implement corrective… more
- University of Pennsylvania (Philadelphia, PA)
- …Specialist C, prepares submissions to the FDA in CTD or eCOPY format, conducts quality reviews of all regulatory documents for submission and any data reports, and ... templates). This individual communicates independently at all levels and ensures audit /inspection readiness of assigned projects. The Regulatory Affairs Specialist C… more
- Medtronic (Los Angeles, CA)
- …a Compliance Manager, you will have responsibility for leading the compliance audit program for the Medtronic Diabetes business. The Compliance Manager is ... responsible for managing the compliance audit program, for internal, external and supplier audits at...in the office and 2 days working in a remote capacity. A Day in the Life: Responsibilities may… more
- Fujifilm (Salem, OR)
- …Director, Finance and Accounting. + Prepare documentation & support internal and external audit requirements as needed + Adheres to the Company's quality and ... + Medical, Dental, Vision + Life Insurance + 401k + Paid Time Off *\#LI- Remote _In the event that COVID-19 vaccine mandates issued by the federal government, or… more
- Pfizer (Helena, MT)
- …for the Regional Business Directors. Manage expenses including Concur input, conduct initial quality check of Concur submissions, and audit for compliance PTE ... is in line with an unwavering commitment to the quality and the delivery of safe and effective products...MS Teams, Ariba, Workday, MS Outlook, MS Excel, vendor credentialing , field rosters, and distribution lists. + Assist with… more
- Health Care Service Corporation (Albuquerque, NM)
- …Conga. In addition, this person will manage ad-hoc requests for the credentialing and re- credentialing processes, update provider demographic information, and ... pull contracts for legal, audit , and compliance purposes. **Required Job Qualifications:** + 4...Flex (Hybrid) role: 3 days in office; 2 days remote .** **Sponsorship is not available.** \#LI-MW2 \#LI-Hybrid **Are you… more
- Medtronic (Minneapolis, MN)
- …well as ensuring product safety with product test review, data trending, audit support, and performing non-conformance investigations. Join a team of passionate ... samples or stability samples in support of the company's quality program. + Develop, validate, and implement controlled environment...is required but willing to accommodate 1 day of remote work a week + Flexible and open minded… more
