- 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
- 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
- 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
- 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
- Humana (Montgomery, AL)
- …caring community and help us put health first** The Senior Stars Improvement Consultant / Professional executes the overall Medicare Stars Improvement Program ... Maintain collaborative relationships with internal partners (PE, MRA, Interop, Clinical Team, etc.) + Instill focus on Stars/ Quality...need it. These efforts are leading to a better quality of life for people with Medicare ,… 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
- State of Colorado (Denver, CO)
- …and unit director to develop new and improved review methodologies + Quality Assurance/ Consultant type background + History of working independently, managing ... NURSE CONSULTANT Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4715738) Apply NURSE CONSULTANT Salary $98,448.00 - $137,844.00 Annually… more
- Public Consulting Group (Columbus, OH)
- …www.publicconsultinggroup.com . PCG is seeking candidates for a Project Manager (Fire & EMS Consultant ) position who will work as an integral part of a dynamic team ... along with peers and senior staff. The Fire/EMS Consultant will be responsible for carrying out the day-to-day...public safety consulting business line, and other Medicaid and Medicare related projects. This role will use knowledge of… more
- Vatica Health (Montgomery, AL)
- …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
- 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
- CVS Health (Austin, TX)
- …rotations per year, as well as holidays and evening rotations. + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, ... to facilitate appropriate healthcare services/benefits for members. + Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- CVS Health (Springfield, IL)
- …Monday: 7am- 6pm EST , Saturday and Sunday: 7am- 5:30pm EST._** Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, ... to facilitate appropriate healthcare services/benefits for members. + Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- Spaulding Rehabilitation (East Sandwich, MA)
- Clinical Documentation Specialist, 20 hours - ( 3307405 ) **Description** Under the direction of the Clinical Documentation Integrity (CDI) Manager, facilitates ... improvement in the overall quality , completeness, and accuracy of medical record documentation to...accuracy of medical record documentation to ensure compliance with Medicare and Medicaid (CMS) regulations and guidelines and assure… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …daily rounds in the HHS core laboratory and serve as a liaison and clinical consultant to internal and external stakeholders including medical staff, laboratory ... advise on issues affecting operations * Consult on test menus, appropriateness, clinical correlations and interpretations, utilization, quality , and new test… more
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