- 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
- Community Health Systems (Naples, FL)
- …meet deadlines. + Effective written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... Benefits **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical… 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
- Defense Health Agency (Oklahoma City, OK)
- **Overview** **Advanced Practice Registered Nurse , Tinker AFB, Oklahoma** Tinker AFB is located in Oklahoma City, Oklahoma. Oklahoma City offers all of the ... is permitted. Apply for this Job Online (https://careers-civilianmedicaljobs.icims.com/jobs/8586/advanced-practice- registered - nurse -%28family%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336268516) **Location** _US-OK-Oklahoma City_ **Job… more
- Catholic Health Services (Flushing, NY)
- …why Catholic Health was named Long Island's Top Workplace! Position Summary: 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...clinical leadership and is a resource for staff. The Registered Nurse must show an uncompromising commitment… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Clinical Nurse Specialist is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with ... facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and… 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: Mar 15, 2025...Participate in quality assurance activities including meetings and peer review . + Ensure cooperation and coordination between Clinical Services… more
- Excellus BlueCross BlueShield (Utica, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... All Levels + Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist licensure required. + Minimum… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Nurse Specialist serves as the key resource for the investigation of member complaints, grievances, quality of care and ... studies through data collection, data input and report development. The QM Nurse Specialist will adhere to NCQA, State, Federal and other Regulatory agency… more
- Elevance Health (Sacramento, CA)
- **Wellness Nurse Consultant** **Sign-On Bonus: $5000** **Federal Employee Program - FEP** , a proud member of the Elevance Health, Inc. family of companies, it is a ... is the territory/market in which they will work._ The **Wellness Nurse Consultant** position is responsible for developing and recommending customized,… more
- Catholic Health Initiatives (Houston, TX)
- …consultation and education to providers and provider staff. **Licensure Required** + Registered Nurse ( RN ) licensure **Minimum Knowledge, Skills, Abilities ... related HEDIS record collection and measures improvement with analytical review /evaluation and / or Quality Improvement. Experience in data and chart reviews… 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
- 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
- Humana (New Orleans, LA)
- …your skills to make an impact** **Required Qualifications** + Master's Degree + Louisiana-licensed registered nurse OR advanced practice registered nurse ... and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers. + 5+ years of management experience in operations + 5+ years… 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
- Centene Corporation (Harrisburg, PA)
- …Health insurance experience required; 1+ year quality experience preferred. **License/Certification:** Registered Nurse , Licensed Practical Nurse , Licensed ... priority metrics + Collaborate through ad hoc initiative requests and scorecard review and to support initiative development and implementation + Create, maintain… 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