Government Programs Quality Auditor
3 days ago
CareFirst is seeking a highly skilled Government Programs Quality Auditor to join our team. This role plays a critical part in evaluating clinical quality and procedures within our Government Programs, ensuring compliance with regulatory standards.
Responsibilities- Evaluate clinical appeals and grievance letters/documentation for accuracy and completeness
- Analyze data to identify areas for improvement and develop strategies to enhance quality metrics
- Collaborate with cross-functional teams to develop education resources and training programs
- Establish effective partnerships with other business units to drive quality initiatives
- Bachelor's Degree in Nursing or equivalent experience
- 5 years of clinical nursing experience, including 3 years of quality auditing and improvement
- Strong analytical and problem-solving skills, with ability to communicate complex information effectively
- Experience working with government programs, utilization management, and managed care preferred
$94,516 per year
-
Experienced Senior Auditor
3 weeks ago
Baltimore, Maryland, United States 1st Choice, LLC Full timeJob OverviewWe are seeking a highly qualified Senior Auditor with a strong background in auditing for non-profit and governmental entities.This role is responsible for planning, executing, and overseeing complex audits while providing leadership and guidance to junior audit staff. The ideal candidate is adept at handling high-pressure situations and...
-
Government Technology Analyst
5 days ago
Baltimore, Maryland, United States Contact Government Services, LLC Full timeAbout the RoleThis Government Technology Analyst - System Improvement position plays a critical role in supporting various aspects of the company's portfolio. The successful candidate will be motivated, highly skilled, and creative, with a passion for contributing to government innovation. They will appreciate collaboration and be able to anticipate the...
-
Pharmacy Technician Auditor
2 weeks ago
Baltimore, Maryland, United States LifeBridge Health Full timeAbout the RoleWe are seeking a detail-oriented Pharmacy Technician Auditor to join our team at LifeBridge Health. In this role, you will perform internal audits to ensure compliance with third-party payer requirements and other regulations.ResponsibilitiesConduct internal audits of pharmacy operations to ensure compliance with regulatory standardsAssist the...
-
Strategic Governance Leader
2 weeks ago
Baltimore, Maryland, United States L.I.F.E., INC Full timeAbout L.I.F.E., INCL.I.F.E., INC is a nonprofit organization dedicated to serving individuals with Intellectual Disabilities (ID) and other disabilities in residential, vocational, and medical day settings. With a strong commitment to promoting self-centered practices, our agency ensures that all individuals receiving services are the drivers of those...
-
Cloud Security Governance Specialist
3 weeks ago
Baltimore, Maryland, United States The ACI Group, Inc. Full timeJob OverviewThe ACI Group, Inc. is seeking a skilled Cloud Security Governance Specialist to support their client's Software as a Service (SaaS) Governance program.
-
Baltimore, Maryland, United States Peraton Full timePeraton Job Opportunity**Job Overview**: We are seeking a highly skilled Program Analyst/Requirements Manager to support the Enterprise and Resource Management office for a government customer. This individual will assist in establishing and maintaining government's portfolio management capability by developing, implementing, monitoring, and supporting...
-
Government Identity Specialist
5 days ago
Baltimore, Maryland, United States Citizant Full timeAbout CitizantCitizant is a leading provider of professional IT services to the U.S. government, seeking talented individuals who share our core values: Drive, Delivering Excellence, Reputation, Responsibility, and a Better Future.As a valued member of our team, you will have the opportunity to work on challenging projects, develop your skills, and...
-
Data Specialist Lead
1 month ago
Baltimore, Maryland, United States CGS Full timeAt CGS, we're committed to delivering customized solutions that fit our client's specific needs. As a Data Specialist Lead, you'll play a vital role in helping our government client process data using LAW. With your expertise, you'll be responsible for loading large volumes of production data, running exports from the database, and performing quality control...
-
Healthcare Reimbursement Specialist
2 weeks ago
Baltimore, Maryland, United States CBIZ Full timeWe are committed to investing in your career development and providing the necessary resources to help you succeed.Position Overview:The Senior Auditor/Accountant will review provider cost reports, analyze health care provider financial information, and perform reimbursement calculations. Independently perform various analyses and audits relating to Medicaid...
-
CICS Systems Developer
3 weeks ago
Baltimore, Maryland, United States Koniag Government Services Full timeJob OverviewWe are seeking a highly skilled CICS Systems Developer to join our team at Koniag Government Services. This role involves developing, customizing, and troubleshooting the CICS architecture, ensuring seamless system performance and efficiency.Key ResponsibilitiesAnalyze high-level requirements and develop detailed design documents to drive...
-
Quality Improvement Nurse Lead
3 days ago
Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full timeKey ResponsibilitiesEvaluate clinical quality and procedures within the Clinical Appeals & Grievance Department for Government Programs, ensuring compliance with regulatory standards.Audit clinical appeals and grievance letters/documentation, reporting and analysis to support quality improvement initiatives.Collaborate with other business units, including...
-
Quality Assurance Expert for Food Manufacturing
3 weeks ago
Baltimore, Maryland, United States Crown Cork & Seal USA, Inc. Full timeCrown Cork & Seal USA, Inc., a global leader in the design and manufacture of packaging products, is seeking a highly skilled Quality Assurance Expert to join our team.We offer competitive compensation, including an estimated annual salary range of $120,000 - $180,000, comprehensive benefits, and opportunities for career growth.Job OverviewThe Sr. Manager,...
-
Data Programs Leadership Position
2 weeks ago
Baltimore, Maryland, United States InsideHigherEd Full timeSenior Director for Data ProgramsLocation: Hybrid/Homewood CampusEstimated Salary Range: $111,800 - $220,000 Annually (Exempt)About UsWe are a leading organization dedicated to excellence in government and public innovation. Our mission is to support senior government leaders across the United States, Canada, and Latin America in using data to drive better...
-
Baltimore, Maryland, United States Crown Cork & Seal USA, Inc. Full timeAbout the RoleWe are seeking a highly experienced and skilled Sr. Manager, Total Quality to provide expert-level quality assurance, continuous improvement, and food safety guidance to Crown's Food Manufacturing facilities.Job DescriptionThis role has an emphasis on 3-piece can manufacturing and oversight of the Hanover, PA; Effingham, SC; and Oshkosh, WI...
-
Program Director for Medicare Drug Pricing
2 weeks ago
Baltimore, Maryland, United States The ACI Group Full timeAbout the job: A career-defining opportunity awaits a seasoned Program Director to lead the management of all work performed under the Medicare Drug Pricing contract. This remote position requires strong leadership and communication skills to facilitate seamless collaboration between CMS and the contractor's team.Full-time role with 100% remote work...
-
CICS Systems Architect
3 days ago
Baltimore, Maryland, United States Koniag Government Services Full timeKoniag Government Services is seeking a highly skilled CICS Systems Architect to join our team in Baltimore, MD. The ideal candidate will have at least 10 years of experience in CICS system programming and possess expertise in various field concepts, practices, and procedures.The salary for this position is approximately $120,000 - $180,000 per year,...
-
CICS System Programmer
3 days ago
Baltimore, Maryland, United States Koniag Government Services Full timeKoniag Government Services is seeking a skilled CICS System Programmer to join our team in Baltimore, MD. The ideal candidate will have at least 10 years of experience in CICS system programming and possess demonstrated expertise in a variety of the field's concepts, practices, and procedures.The estimated annual salary for this position is around $150,000 -...
-
Early Childhood Education Program Manager
3 weeks ago
Baltimore, Maryland, United States The Y of Central Maryland Full timeAbout The Y of Central MarylandWe are a charitable, mission-driven organization dedicated to individual and community well-being for all. Our vision is a better us.Job SummaryThis position serves as a Head Start Site Director for clustered Y Head Start centers and Y Head Start sites located in Public Schools. The Head Start Site Director supervises early...
-
IT Program Manager
3 weeks ago
Baltimore, Maryland, United States Creative Information Technology, Inc. Full timeJob Title: Program ManagerJob DescriptionAbout Us:Creative Information Technology, Inc. (CITI) is a renowned IT enterprise known for its exceptional customer service and innovation. We serve both government and commercial sectors, offering a range of solutions such as Healthcare IT, Human Services, Identity Credentialing, Cloud Computing, and Big Data...
-
Program Director Project Manager
3 weeks ago
Baltimore, Maryland, United States Lesotho YP Full timeLesotho YP is seeking a highly skilled and experienced Program Director Project Manager to lead our HIV/TB program in Lesotho. This is a fixed-term contract position with a competitive salary.About the Job:We are looking for a senior expert who will oversee the implementation of our project, ensuring strategic, programmatic, technical, and financial...