Healthcare Quality Management Auditor Jobs

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Serves as the central execution and coordination lead for complex, cross-functional initiatives within the Medicare Part D product and strategy organization. Establishes clear visibility into what initiatives exist, who owns them, how they are progressing, and what dependencies must be managed to deliver results on time. Translates strategic priorities into structured plans, timelines, progress tracking, and executive-ready summaries that help leadership assess status, risks, and next steps. Required Qualifications 7–10 years of relevant experience, including project, program, or initiative management in healthcare, insurance, or a related field. Strong working knowledge of Medicare Part D, including regulatory, operational, and product considerations. Demonstrated ability to manage multiple complex initiatives simultaneously and translate strategic priorities into operational plans with measurable outcomes. Exceptional organizational skills with strong attention to detail and the ability to manage dependencies, sequencing, and critical paths. Proven experience creating clear summaries, dashboards, timelines, roadmaps, and visuals for senior leadership. Strong written and verbal communication skills, including the ability to frame communications for executive and cross-functional audiences. Experience supporting Medica

Job Title Disease management Solutions Clinical Support Specialist (90% Travel M-F) Job Description Disease management Solutions Clinical Support Specialist (90% Travel M-F) Help healthcare providers maximize the value of Philips Disease Management Solutions by delivering expert clinical training, product education, and implementation support across a highly customer-facing field role. Your role: Deliver hands-on and remote clinical training for Philips Disease Management Solutions products, with primary focus on DynaCAD and UroNav, ensuring customer competency and successful adoption. Serve as a trusted clinical consultant to physicians and technologists, providing education, workflow guidance, and application support that improves customer productivity and outcomes. Partner closely with Sales, Marketing, Service, Customer Support, Quality, Research & Development, and Manufacturing teams to support customer success, product implementations, and new product introductions. Demonstrate product expertise, you will be responsible for product assembly and installation for the UroNAV product as well as troubleshoot software and workflow issues, and help customers optimize their use of advanced imaging and post-processing solutions. Travel extensively (approximately 90%) to customer sites throughout the U.S., working from a home-based office and supporting changing customer locations as business needs require. You're the right fit if: You’ve acquired 5+ years of clinical experience as an MRI Technologist and/or Ultrasound Technologist, with strong knowledge of imaging workflows and patient care environments. Your skills include troubleshooting software, computer, networking, and basic Digital Imaging and Communications in Medicine (DICOM) issues, along with strong teaching, presentation, a

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Preference for those residing in mountain or pacific time zones. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sit

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant (RN) Make a meaningful impact on patient care from wherever you are. We are seeking an experienced Registered Nurse (RN) to join our Utilization Management team. In this role, you will use your clinical expertise to review healthcare services, support appropriate care decisions, collaborate with providers, and help members navigate their healthcare journey. What You'll Do Review clinical information and apply evidence-based criteria to make coverage recommendations. Collaborate with healthcare providers and internal teams to support quality patient outcomes. Identify opportunities for care coordination and member support programs. Promote effective healthcare utilization and contribute to high-quality service delivery. Manage multiple systems and priorities in a fast-paced, team-oriented environment. Required Qualifications Active, unrestricted RN license in your state of residence. Minimum 2 years of RN experience in an adult acute care or critical care setting . Associate's Degree in Nursing. Strong communication, computer, and multitasking skills. Ability to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation. Preferred Qualificatio

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Work from Home | Eastern Time Zone Preferred Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review, care coordination, and healthcare advocacy. What You'll Do Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality of care, member outcomes, and healthcare utilization Connect members with additional programs and resources that support their healthcare needs Serve as a clinical resource for internal and external stakeholders WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence 2+ years of adult acute care and/or critical care nursing experience Strong clinical assessment, critical thinking, and decision-making skills Excellent verbal and written communication skills Ability to multitask and

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Work from Home | Eastern Time Zone Preferred Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review, care coordination, and healthcare advocacy. What You'll Do Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality of care, member outcomes, and healthcare utilization Connect members with additional programs and resources that support their healthcare needs Serve as a clinical resource for internal and external stakeholders WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence 2+ years of adult acute care and/or critical care nursing experience Strong clinical assessment, critical thinking, and decision-making skills Excellent verbal and written communication skills Ability to multitask and

We anticipate the application window for this opening will close on - 16 Oct 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life The Quality Engineering function within Service and Repair is responsible for ensuring compliance, product quality, supplier quality technical support and continuous improvement across service center and field service operations. This team partners closely with Engineering, Regulatory, Supplier Quality, Post-Market Quality, and Operating Units to support quality system requirements, continuous improvement initiatives, supplier management, audit readiness, and the introduction and sustainment of products throughout the service lifecycle. The Service & Repair Quality Engineer II provides quality engineering support for a global Service and Repair organization. This role partners cross-functionally to maintain compliance with quality system requirements, support daily operations, drive resolution of quality issues, support supplied products and processes, and ensure audit readiness across service center and field service activities. The Quality Engineer II also plays a key role in Corrective and Preventive Action (CAPA) activities, process validation efforts, and continuous improvement initiatives that support operational performance and product quality. This role is based in Rice Creek, Minnesota and requires onsite presence 5 days per we

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Program Overview: Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. This position is focused on assisting members in: Kankakee, Iroquois, Livingston, Ford, Champaign and surrounding counties. Position Summary/Mission: The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources. Fundamental Components • Evaluation of Members: Through the use of care management tools and information/data

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a full-time telework position requiring 50-75% travel in the Metro East Regional counties, Illinois (Madison, St. Clair, Monroe, Clinton, Jersey, Calhoun, Macoupin, and Bond counties.) Hours for this position are Monday-Friday 8:00a-5:00pm Central Time. Position Summary The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources. • Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. • Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. • Coordinates and implements assigned care plan activities and monitors care plan progress. • Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach con

We anticipate the application window for this opening will close on - 28 Sep 2026 Careers that change lives start here. Medtronic is a global leader in healthcare technology with a Mission to alleviate pain, restore health, and extend life. Our 95,000 employees work across more than 150 countries to put patients first — developing innovative medical technologies that improve the lives of 72+ million patients each year. Your unique talents will help shape the future of healthcare while building a career grounded in purpose, growth, and impact. A Day in the Life The Cardiac Rhythm Management (CRM) portfolio delivers therapies designed to restore, support, and protect every heartbeat through advanced pacing, defibrillation, and remote monitoring solutions. CRM's unique ability to pair proven life-saving therapies with intelligent technology gives clinicians and patients greater confidence. Clinical impact and innovation come together to improve lives through meaningful patient outcomes. Provide technical, educational, operational and sales support to assist the district in meeting Cardiac Rhythm Management (CRM) sales and customer service objectives . CR M seeks collaborative candidates who will meet our customer expectations by striving without reserve for the greatest possible reliability and quality in our products, processes, and systems by being accountable, having a voice and acting promptly . This role supports the Baltimore territory and requires candidates to

Join Delphi - Where Innovation meets transformation At Delphi, we believe in creating an environment where our people thrive. Our hybrid work model empowers you to choose where you work—whether it's from the office, your home, or a mix of both—so you can prioritize what matters most. We are committed to supporting your personal goals, family, and overall well-being while driving transformative results for our clients. We welcome exceptional talent from anywhere across the globe. Interviews and onboarding are conducted virtually, reflecting our digital-first mindset. Rooted in the region, we specialize in delivering tailored, impactful solutions in Data, Advanced Analytics and AI, Infrastructure, Cloud Security, and Application Modernization. Whether it’s enabling predictive analytics , transforming operations with automation, or driving customer engagement with intelligent platforms, we are the trusted partner for organizations ready to embrace a smarter, more efficient future. We are looking for a hands-on Senior QA Consultant to lead end-to-end testing of AI and Generative AI applications across enterprise environments. This role combines strong expertise in traditional QA engineering with modern AI evaluation and validation practices. The ideal candidate will drive quality assurance initiatives for RAG pipelines, multi-agent systems, OCR and Speech-to-Text solutions while ensuring production grade quality outcomes in regulated industries such as Finance, Healthcare, and Insurance. The successful candidate will lead a small QA pod, collaborate closely with engineering, AI/ML, product, and business teams, and act as the client-facing QA owner for enterprise AI engagements. This role requires strong technical leadership, automation expertise, AI evaluation capabilities, and excellent stakeholder management skills. Experience Requirements • 7–10 years of experien

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary – Case Manager Analyst - Field Location: Will & DuPage Counties, IL Must reside in one of the following Zip Codes: 60606, 60607, 60608, 60609, 60610, 60611, 60612, 60614, 60622, 60623, 60624, 60632, 60639, 60644, 60647, 60651, 60653 This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team and is a field-based position. The requirement is for candidates to travel up to 75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meeting contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary – Case Manager Analyst - Field Location: Champaign, IL This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team. The requirement is for candidates to travel 75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meeting contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case man

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary **Qualified candidates will sit in either Texas or Atlanta, Georgia area due to book of business** The NAT Accounts Senior Director of Account Management leads a team of Account Executives supporting large, complex National Accounts. This leader is responsible for customer retention, profitable growth, client satisfaction, account strategy, and effective execution across an assigned portfolio. The Senior Director partners with Sales, Client Management, Underwriting, Operations, Network, Clinical, Product, and other enterprise teams to address customer needs, manage business risks, and deliver measurable value. The role requires strong healthcare-industry knowledge, sound business judgment, executive-level communication, and the ability to lead through a complex organization. **In addition to a base salary, this opportunity is eligible for Sales Incentive Compensation + Stock options* * What you will do Lead, coach, and develop a high-performing team of Account Executives. Establish clear priorities, performance expectations, and accountability across the team. Oversee customer strategies focused on retention, growth, financial performance, member experience, and client satisfaction. Identify customer and portfolio risks early and lead the development of mitigation plans. Build

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary As a Senior Product Manager, you will lead product strategy and roadmap development for the organization's Epic electronic health record (EHR) platform and integrated clinical informatics tools. You will own the product strategy and requirements for our Revenue Cycle Management (RCM) domain, which is focused on CDI, coding, billing, collections, integrity and analytics. These are critical for ensuring the end to end workflow from accurate clinical documentation to appropriate coding and A/R completeness. You’ll apply deep Epic platform expertise, user-centric design, and agile methodologies to drive adoption, quality, and safety across enterprise informatics initiatives to improve healthcare delivery for our patients. What You'll Do Responsible for defining the product vision and strategic direction for your Epic Domain, ensuring continuous alignment with senior business and engineering leaders. You'll translate high-level business goals into a clear, actionable product strategy that are tied to OKRs. Partner with business stakeholders to define the product roadmap, overseeing day-to-day backlog management and prioritization to ensure alignment with your strategic vision. You will assess value and develop business cases to inform the nature and scope of new initiatives. This includes evaluating buy vs. build opportunities and identifying