- Point32Health (MA)
- …processes associated with the review of medical records. The Quality Nurse Reviewer is responsible for working independently to retrieve, review ... are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Quality Nurse Reviewer has responsibility for ensuring the quality and… more
- Ventura County (Ventura, CA)
- …care services to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing ... amount of supervision commensurate with their experience. PAYROLL TITLE: Senior Registered Nurse - Ambulatory Care AGENCY/DEPARTMENT: Health Care Agency… more
- Molina Healthcare (Phoenix, AZ)
- …QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Improvement ( Registered Nurse ) contributes to one or more of ... lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing...+ Certified Professional in Health Quality (CPHQ) + Certified HEDIS Compliance Auditor (CHCA) + Registered Health… more
- The Cigna Group (Birmingham, AL)
- …available to work onsite at providers office. **Experience:** * Current Licensure as a Registered Nurse , in the state of Alabama in good standing. * Associates ... utilization management position (experience can be a combination of LVN/ RN licensure) * Previous HEDIS and/or CMS...knowledge- able to type 35WPM * Knowledge of utilization review requirements and procedures * Knowledge of current health… more
- Catholic Health Services (East Hills, NY)
- Overview The Registered Nurse provides safe, direct patient care utilizing the nursing process in the ambulatory setting. The RN provides clinical leadership ... and is a resource for staff. The Registered Nurse must show an uncompromising commitment...in staff meetings and huddles as appropriate. Participates in Hedis , GPRO, and other quality programs as needed Enters… more
- The Cigna Group (Franklin, TN)
- The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... coordinate and streamline all services offered within Evernorth. The RN Coordinator will educate the patient on healthcare options,...and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all… more
- Medical Mutual of Ohio (OH)
- …Nursing preferred.Master's Degree a plus. + 3 years clinical experience as a Registered Nurse preferably in a health plan. **Professional Certification(s)** + ... lines of business.** + **Applies clinical expertise to collect HEDIS and/or study data through chart review ...Registered Nurse with current State of Ohio...Registered Nurse with current State of Ohio unrestricted license. +… more
- Fallon Health (Lawrence, MA)
- …related field preferred **License/Certifications:** + Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver's license and reliable ... providers and office staff and may lead care plan review with providers and care team as applicable +...**Experience:** + 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... the continuum of care. Spinal Cord Serves as the RN Team Leader for a team of patients with...devises strategies to improve Healthcare Effective Data Information Sets ( HEDIS ) metrics, clinical reminders, panel access, timely encounter closures,… more
- Commonwealth Care Alliance (Springfield, MA)
- …etc. + Identify and initiate a plan to meet quality, STAR, and HEDIS measures. + Conduct Annual Visits with patients, taking a detailed history, performing ... or hospitalization. Such visits include a detailed history of present illness, review of systems, physical exam, ordering of appropriate studies and tests,… more
- AdventHealth (Westwood, KS)
- …Data Analysis related to healthcare. **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . Registered Nurse **Preferred qualifications:** . Registered ... current expertise on quality measures (including but not limited to ACO, CMS, HEDIS etc) . Support and maintain outreach initiatives and other quality improvement… more
- University of Miami (Miami, FL)
- …+ Clinical and management work experience, required Certification and Licensing: + Registered Nurse License preferred + Quality and/or patient safety ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
- CVS Health (Chicago, IL)
- …development, modeling inclusive behaviors, and proactively managing bias **Preferred Qualifications** + Registered Nurse , preferably in the state of IL + ... of the Quality team to ensure maximal performance with HEDIS and accreditations. + Serving as the SPOC on...such as monitoring report owners and the timely quality review of these reports and works with COO and… more
- Veterans Affairs, Veterans Health Administration (Chesapeake, VA)
- …ENT, Oncology, Women's Health, etc.). Coordinates with the patient care team (LPN, RN , Clinician/Provider, Social worker, Pharmacist, etc.). to review the clinic ... report, secure messages, VeTEXT, VAR, as well as SAIL/ HEDIS metrics that directly impact the PACT team's metrics...provisions may not apply to this occupation. Please carefully review the qualification standard to determine the specific education… more