- Insight Global (Philadelphia, PA)
- …patient's care needs. The HEDIS nurse focuses solely on using HEDIS measuring criteria to review health plans in accordance with healthcare facility ... Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements Previous HEDIS review experience Active RN License… more
- Insight Global (Philadelphia, PA)
- …) Strong computer skills Ability to occasionally travel to local providers Previous HEDIS review experience or experience with Utilization Review , Quality, ... Description A client of Insight Globals is looking for HEDIS RNs or LPNs for a partially remote contract...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
- Veterans Affairs, Veterans Health Administration (El Paso, TX)
- Summary The Quality Management (QM), Performance Measures Coordinator, Registered Nurse functions as an advanced clinician and executes position responsibilities ... a group of patients. Responsibilities The Quality Management (QM), Performance Measures Coordinator, Registered Nurse duties, include but are not limited to the… more
- The Cigna Group (Philadelphia, PA)
- 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 ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...and participates in patient education and outreach tied to HEDIS initiatives 4. Works to improve access to care… more
- Hackensack Meridian Health (Neptune, NJ)
- …in Nursing. **Licenses and Certifications Required:** + NJ State Professional Registered Nurse License. **Licenses and Certifications Preferred:** + Professional ... to transform healthcare and serve as a leader of positive change. The ** RN , Community Based Care Management** provides direct support to physician practices and… more
- Community Health Systems (Naples, FL)
- …meet deadlines. + Effective written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... the Utilization Review (UR) Director/Manager the Utilization Review (UR) Nurse reviews all admissions for...+ 2-4 years clinical practice experience required + Utilization Review experince preferred + Experience in HEDIS ,… more
- Molina Healthcare (WA)
- …QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Improvement ( Registered Nurse ) contributes to one or more of ... supporting our Washington State Plan. We are seeking a Registered Nurse with quality improvement experience. The...lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing… more
- AmeriHealth Caritas (Dublin, OH)
- …+ Associate's Degree or equivalent work experience + Bachelor's Degree preferred + Registered Nurse required + Minimum of 3-5 years in clinical or ... addition, responsibilities also include supporting the annual medical record review activities including HEDIS and, Clinical Practice...3-5 years in healthcare quality required + An unrestricted registered nurse license in the plan's state… more
- MyFlorida (St. Petersburg, FL)
- …and Excellence in all aspects of their work. The OPS Advanced Practice Registered Nurse Specialist is responsible for providing comprehensive health care to ... OPS ADVANCED PRACTICE RN SPECIALIST - 64952403 Date: Feb 14, 2025...Participate in quality assurance activities including meetings and peer review . + Ensure cooperation and coordination between Clinical Services… more
- Centene Corporation (Jefferson City, MO)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... field or equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill… more
- Elevance Health (Rancho Cordova, CA)
- **Wellness Nurse Consultant** **Sign Bonus: $5000** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a ... is the territory/market that they will work in._ The **Wellness Nurse Consultant** position is responsible for developing and recommending customized, group-specific… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 1 **Shift Start Time** **Shift End Time** Master's Degree in Nursing; California Registered Nurse ( RN ) - CA Board of Registered Nursing; ... AlignMeasurePerform (AMP); Pay for Performance (P4P) metrics; Medicare Stars; HEDIS ; Performance Guarantees and metrics; and other quality measurement...5 Years experience in a leadership role. + California Registered Nurse ( RN ) - CA… more
- Centene Corporation (Olympia, WA)
- …in Behavioral Healthcare field preferred. **For Coordinated Care -** **Washington only** : Registered Nurse ( RN ), Licensed Clinical Social Worker (LCSW), ... Professional Clinical Counselor (CC/LPCC), Chemical Dependency Professional (CDP). **Licenses/Certifications:** Registered Nurse ( RN ) certification, Licensed… more
- HCA Healthcare (Salt Lake City, UT)
- …managing high-risk, multi-morbidity patient populations.** **What qualifications you will need:** + Registered Nurse + Graduate of an accredited college of ... Medical Home (PCMH), government programs (CMS), accountable care organizations (ACOs), HEDIS , and experience with payor cost sharing initiatives + Excellent oral… more
- Dignity Health (Bakersfield, CA)
- …special projects as assigned. **Qualifications** **Minimum Qualifications:** - CA Clinical licensure ( Registered Nurse ( RN ), Licensed Vocational Nurse ... clinical and non-clinical quality management staff. - 3 years HEDIS measures reporting and experience in CMS Stars, P4P,...Value Based Payment Programs. - 3 years Medical record review project management. - Bachelor's degree or equivalent in… more
- University of Miami (Miami, FL)
- …Providers supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of ... Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and...Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of Hierarchical Condition… more
- Medical Mutual of Ohio (OH)
- …+ **Medical /clinical background highly desirable.** **Professional Certification(s)** + ** Registered Nurse preferred** + **Certified Professional Coder (CPC) ... _Collaborates with internal departments on risk adjustment coding strategies, HEDIS performance, provider performance, and other corporate quality initiatives.… more
- CVS Health (Springfield, 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