- Highmark Health (Harrisburg, PA)
- …Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the ... or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is...as needed/defined by market outcomes. + Serve as the clinical subject matter expert for PCP Medicare … more
- Vanderbilt University Medical Center (Nashville, TN)
- …implementations of systematic and procedural changes to ensure compliant and efficient clinical billing activities. Assists with both internal and external audits of ... to promote regulatory compliance; + Assistance in monitoring the workflows/processes in key clinical areas for revenue related control risks; and + Assistance in the… more
- Humana (Nashville, TN)
- …help us put health first** The RN Senior Stars Improvement, Clinical Consultant / Professional executes the overall Medicare Stars Improvement Program within ... Maintains collaborative relationships with internal partners (Provider Engagement, Finance, Medicare Risk Adjustment, Interoperability, Clinical Team, Contracting,… more
- Signature Healthcare (Louisville, KY)
- …"Best Places to Work!" Overview The ideal Signature Clinical Care Consultant Candidate would have working knowledge of Medicare , Medicaid and Managed ... telemedicine. A growing number of our centers are earning quality assurance accreditation and pioneering person - directed care....4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The goal of the Clinical Documentation Specialist- Consultant is to educate leaders, physicians, advanced practice providers (APP), and other ... in order to improve the accuracy of the overall clinical picture and the representation of the complexity and...interventions, and training. + Acts as an education leader, consultant , and mentor to leaders, physicians, APP's, and other… more
- Elevance Health (Atlanta, GA)
- …is received. May be responsible for developing and implementing programs to improve quality , cost, and outcomes. May provide clinical consultation and serve as ... ** Medicare Medical Director** Location: This position will work...Leads, develops, directs, and implements clinical and non- clinical activities that impact health care quality … more
- VNS Health (Manhattan, NY)
- … clinical expertise, in depth data analysis and interpretation designed to improve clinical outcomes. . Serves as consultant for unusual and difficult medical ... state management and health enhancement programs that support the appropriate use of clinical resources in the delivery of consistent high- quality medical care.*… more
- CVS Health (Tallahassee, FL)
- …convenient and affordable. **Position Summary** This is a full-time remote Quality Management Nurse Consultant opportunity. Working schedule is Monday-Friday, ... Patient Safety Events across all lines of business (Commercial, Medicare , and Medicaid). Independently coordinates the clinical ...support as required. + Reviews documentation and evaluates Potential Quality of Care issues based on clinical … more
- CVS Health (Phoenix, AZ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant opportunity within Arizona. The working ... miles) about 25-50% of the time. The QM Nurse Consultant is a work at home role. Experienced HEDIS...tool. + Typical office working environment with productivity and quality expectations. + Professional customer service demeanor a plus… more
- US Tech Solutions (RI)
- …clinician support as required. **Responsibilities:** + Reviews documentation and evaluates potential quality of care issues based on clinical policies and ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
- HCA Healthcare (Nashville, TN)
- …**Job Summary and Qualifications** The Coding Operations Education and Appeals Consultant is responsible for assisting in the efficient and effective design, ... seeking to understand, meet, and exceed customer expectations and needs. The Education Consultant is responsible for assisting in the development of the Quality … more
- WellSense (Boston, MA)
- Sr. Provider Relations Consultant - (MA residents)-$5,000 sign on bonus WellSense Health Plan is a nonprofit health insurance company serving members across ... Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25...prepares and conducts orientations of network providers (administrative and clinical ) and their staff + Takes the lead on… more
- MyFlorida (Delray Beach, FL)
- 68030839 - PUBLIC HEALTH NUTRITION CONSULTANT Date: Nov 19, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... for Health Care Administration Working Title: 68030839 - PUBLIC HEALTH NUTRITION CONSULTANT Pay Plan: Career Service Position Number: 68030839 Salary: $1,938.35 -… more
- Vatica Health (Louisville, KY)
- …clinically experienced and detailed-oriented nurses to join our team. As a Nurse Consultant , you will collect, review and analyze patient data to improve care ... coordination, quality metrics, and medical cost savings. The ideal candidate...and consolidate into one comprehensive and detailed view. Use clinical judgement and data to reconcile conflicting information from… more
- Vatica Health (Glasgow, KY)
- …clinically experienced and detailed-oriented nurses to join our team. As a Nurse Consultant , you will collect, review and analyze patient data to improve care ... coordination, quality metrics, and medical cost savings. The ideal candidate...and consolidate into one comprehensive and detailed view. Use clinical judgement and data to reconcile conflicting information from… more
- Humana (Tallahassee, FL)
- …solutions + Maintain collaborative relationships with internal partners (PE, MRA, Interop, Clinical Team, etc.) + Instill focus on Stars/ Quality performance + ... Humana Florida Team is seeking a Senior STARS Improvement Consultant / Professional who will work directly with the Stars...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Dialysis Clinic, Inc. (Nashville, TN)
- …Nurse Consultant ** will provide education and training to promote quality patient care, assist our dialysis facilities with improving financial outcomes and ... Quality of Care:** + Facilitates the improvement of clinical and financial outcomes in assigned clinics by helping...Serves as a resource to clinic on interpretation of Medicare and state regulations as well as other agencies.… more
- University of Washington (Seattle, WA)
- …natural beauty. **Department of Emergency Medicine has an outstanding opportunity for Research Consultant .** The University of Washington (UW) is proud to be one of ... of domestic and international health services, impact evaluations, informatics and clinical trials. Examples of current research include improving care of patients… more
- Highmark Health (Columbus, OH)
- …include internal areas of the enterprise such as the strategic, financial, and clinical leadership of the enterprise, in addition to the multiple areas of health ... share and risk share models and will be implemented for the Organization's Medicare Advantage, Medicaid, ACA, and commercial populations with the goal of maximizing … more
- Fallon Health (Worcester, MA)
- …among the nation's top health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, ... to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)-… more