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Results based on filters ( 79 jobs found )

Quality Auditing Team Lead

Keystone First
Philadelphia, PA
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Role Overview: The Quality Auditing Team Lead supports the oversight and ...
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Summary
About the job:
daily operations of the Quality Auditing department. This role leads multiple concurrent audits—including Performance Management, Compliance, and Operational reviews—to ensure adherence to quality standards across AmeriHealth Caritas. This role also contributes to special projects and analytical initiatives that drive continuous improvement. Work Arrangement: - Hybrid - This role requires the associate to be onsite at the Philadelphia, Pennsylvania office at least three days per week, including mandatory in-office days...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Keystone First
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Programmer Analyst Sr

Keystone First
Located in Ohio
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Your career starts now. We’re looking for the next generation of health care ...
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Summary
About the job:
leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Software Developers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Keystone First
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Behavioral Health Utilization Management Reviewer

Keystone First
Located in Ohio
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Role Overview: Under the direction of the Manager, Behavioral Health ...
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Summary
About the job:
Utilization Review , the Behavior Health Utilization Management Reviewer (BHR) is responsible for completing medical necessity reviews. Using clinical knowledge and experience, the clinician reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. Work Arrangement: - Remote role. - Monday through Friday from 8:00a ET to 5:00p ET. Responsibilities: Ensures that appropriate services are...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Master's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Keystone First
Certifications / Licenses:
Licensed Clinical Social Worker
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Training Specialist

Keystone First
Philadelphia, PA
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Role Overview: The Training Specialist is responsible for designing, ...
Details
Summary
About the job:
delivering, and evaluating effective training programs across various topics and organizational levels. This role applies adult learning principles to ensure knowledge retention and skill development, while maintaining professionalism and adaptability in both classroom and virtual environments. Work Arrangement: - Hybrid - This role requires the associate to attend in-person training at the Jacksonville, Florida, Philadelphia, Pennsylvania, Raleigh, North Carolina, or Dublin, Ohio, office as necessary. - Travel up to 25% as...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Training and Development Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Keystone First
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Manager Provider Network Management

Keystone First
Detroit, MI
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Role Overview: The Manager of Provider Network Management oversees the ...
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Summary
About the job:
day-to-day operations of the Network Management department, including staff supervision, provider contracting, recruitment, and compliance. This role ensures the provider network meets regulatory standards and supports the healthcare needs of plan members. The manager also leads initiatives to improve provider satisfaction, streamline processes, and enhance electronic strategies for claims and auto-adjudication. Work Arrangement: - Hybrid -This role requires the associate to be onsite at the Southfield, Michigan (MI)...
Location:
Detroit, MI
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Keystone First
Certifications / Licenses:
National Committee for Quality Assurance
Driver's License
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Credentialing Auditor

Keystone First
Philadelphia, PA
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Role Overview: The Credentialing Auditor is responsible for conducting ...
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Summary
About the job:
quality audits of practitioner and organizational provider files to ensure compliance with National Committee for Quality Assurance (NCQA) standards and state and federal regulations. This role performs initial and ongoing audits, monitors the accuracy of Credentialing Coordinators’ work, and provides constructive feedback to support continuous improvement. The Auditor also collaborates with the Enterprise Credentialing Trainer to identify departmental training needs. Work Arrangement: - Hybrid - This role requires the...
Location:
Philadelphia, PA
Job Type:
Full-Time
Permanent
Occupation:
Compliance Officers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Keystone First
Certifications / Licenses:
National Committee for Quality Assurance
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Market Chief Medical Officer

Keystone First
Baton Rouge, LA
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Role Overview : The Chief Medical Officer (CMO) serves as the senior ...
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Summary
About the job:
clinical executive for the market, reporting directly to the Market President. This role leads the clinical strategy, population health initiatives, and quality improvement efforts to drive better health outcomes and cost-effective care delivery. The CMO collaborates with internal teams, providers, community stakeholders, and regulatory agencies to promote clinical excellence and operational efficiency. Work Arrangement: - Hybrid - The associate is required to work onsite at the Baton Rouge, Louisiana office four (4) days...
Location:
Baton Rouge, LA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
Keystone First
Certifications / Licenses:
Driver's License
Advanced Certification Administrator
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

HEDIS Analyst

Keystone First
Located in Ohio
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Overview Supports corporate, plan-level, and departmental strategies and ...
Details
Summary
About the job:
goals for HEDIS process. Meets this standard by effectively applying both business knowledge and technical expertise to support business initiatives and solve business problems. Work Arrangement This is a remote eligible position working East Coast hours. Must have experience with full HEDIS lifecycle. Responsibilities: Manage the HEDIS lifecycle process for multiple plans. Responsible for assuring the accuracy and validity of both source data and results and interpreting results into recommendations. In collaboration...
Location:
Located in Ohio
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Keystone First
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Finance Director

Keystone First
Manchester, NH
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Role Overview: The Finance Director oversees all accounting and financial ...
Details
Summary
About the job:
operations for the health plan or line of business, including audit coordination, financial planning, reporting, and budget management. This role ensures the integrity and efficiency of day-to-day financial activities and supports strategic financial decision-making. Work Arrangement: - Hybrid - This role requires the associate to be onsite at the Manchester, New Hampshire (NH) office at least three days per week, including mandatory in-office days on Tuesdays and Wednesdays. Responsibilities: - Lead the development and...
Location:
Manchester, NH
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
Keystone First
Certifications / Licenses:
Certified Public Accountant
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Training Specialist

Keystone First
Jacksonville, FL
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Role Overview: The Training Specialist is responsible for designing, ...
Details
Summary
About the job:
delivering, and evaluating effective training programs across various topics and organizational levels. This role applies adult learning principles to ensure knowledge retention and skill development, while maintaining professionalism and adaptability in both classroom and virtual environments. Work Arrangement: - Hybrid - This role requires the associate to attend in-person training at the Jacksonville, Florida, Philadelphia, Pennsylvania, Raleigh, North Carolina, or Dublin, Ohio, office as necessary. - Travel up to 25% as...
Location:
Jacksonville, FL
Job Type:
Full-Time
Permanent
Occupation:
Training and Development Specialists
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
Keystone First
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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