• Sr Analyst, HEDIS / Quality

    Molina Healthcare (MI)
    …federal/state QI compliance activities. **Candidates residing in Michigan with SQL, Quality / HEDIS and Health plan experience are strongly preferred.** ... **KNOWLEDGE/SKILLS/ABILITIES** In collaboration with Quality Improvement (QI) management, the Senior Analyst, HEDIS...to completion + Works with Director and / or Manager to establish and / or document quality more
    Molina Healthcare (10/20/24)
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  • Manager , Clinical Data Acquisition…

    Molina Healthcare (WA)
    …appropriate departments and committees on others. Identifies and recommends potential clinical measurement and quality improvement activities. + Maximizes use ... EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 7+ years experience in managed healthcare Quality / HEDIS project management and HEDIS Audit * Demonstrated… more
    Molina Healthcare (11/10/24)
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  • Clinical Quality Program…

    LA Care Health Plan (Los Angeles, CA)
    Clinical Quality Program Manager III Job Category: Clinical Department: Quality Improvement Location: Los Angeles, CA, US, 90017 Position Type: Full ... net required to achieve that purpose. Job Summary The Clinical Quality Program Manager is...(HOS) and /or Healthcare Effectiveness Data and Information Set ( HEDIS ), Medication Adherence and Plan Operations and /or other… more
    LA Care Health Plan (11/07/24)
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  • Manager , Clinical Quality

    LA Care Health Plan (Los Angeles, CA)
    Manager , Clinical Quality Analytics Job Category: Clinical Department: Quality Improvement Location: Los Angeles, CA, US, 90017 Position Type: Full ... net required to achieve that purpose. Job Summary The Manager of Clinical Quality Analytics...strategies to enable accountable entities and stakeholders to drive quality ratings improvement for CAHPS, HOS, HEDIS ,… more
    LA Care Health Plan (08/28/24)
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  • Clinical Quality Program…

    Elevance Health (Miami, FL)
    **JR131500 Clinical Quality Program Manager **...will you make an impact:** + Leads plan level HEDIS strategy to drive improvement in behavioral health ... reporting is in place. + Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of… more
    Elevance Health (11/16/24)
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  • Manager Clinical Quality

    Dignity Health (Bakersfield, CA)
    …position is remote/work from home** **within California** **.** **Position Summary:** The Manager , Clinical Quality Improvement, is responsible for leading ... that are consistent with the organization's strategic goals. The Manager , Clinical Quality Improvement will...oversight/supervision/management/leadership of clinical and non- clinical quality management staff. - 3 years HEDIS more
    Dignity Health (11/13/24)
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  • Quality Improvement (RN) - Maternity…

    Molina Healthcare (Ypsilanti, MI)
    …RN license for the State(s) of employment **Preferred Education** Preferred field: Clinical Quality , Public Health or Healthcare. Nursing: Master's or higher ... or more of these quality improvements functions: Quality Interventions, Quality Improvement Compliance, HEDIS...quality activities. + Monitors and ensures that key quality activities that involve clinical decision-making are… more
    Molina Healthcare (10/20/24)
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  • Clinical Quality Program…

    Elevance Health (KS)
    …Park office.** **HOURS** **: General business hours, Monday through Friday.** **The Clinical Quality Program Administrator** is responsible for overseeing the ... committees and timely implementation of appropriate interventions. + Oversees the clinical quality improvement activities/projects to implement appropriate … more
    Elevance Health (11/19/24)
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  • Quality and Risk Adjustment - Provider…

    Premera Blue Cross (Mountlake Terrace, WA)
    …for HEDIS and risk adjustment. This role will have a positive impact on our clinical quality and coding quality work. This position will work in the ... with Premera Medical Directors and Provider Network Executives, the ** Quality and Risk Adjustment - Provider Clinical ...and subject matter support. + Clearly, communicate nationally established HEDIS measures and be able to speak to the… more
    Premera Blue Cross (11/13/24)
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  • Center Clinical Manager

    ChenMed (Philadelphia, PA)
    …with the development and execution of business strategies that increase revenue and quality ratings ( HEDIS /STARS/ Clinical Gaps) and support our core model. ... need great people to join our team. The Center Clinical Manager (CCM) at our North Philadelphia...operations, which may include but is not limited to: clinical quality , compliance, human resources, patient experience… more
    ChenMed (09/06/24)
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  • Clinical Programs Manager

    Molina Healthcare (UT)
    …will support our Behavioral Health business overseeing projects. We are looking for a Clinical Programs Manager with a LMSW or LCSW, LCPC/LPC or RN-Psych ... licensure. Broad knowledge of Utilization Management, Case Management and understanding clinical operations is highly preferred.** **The candidate must have a… more
    Molina Healthcare (11/10/24)
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  • Pharmacist Clinical - Provider Support

    Elevance Health (Miami, FL)
    …and Medicaid providers. Duties and responsibilities will be focused on improving quality (STAR and HEDIS ) and cost measures through close collaboration ... to assist contracted physician prescribers in achieving formulary and quality goals. + Serves as a clinical ...and practice-level reports and identifying opportunities to improve pharmacy quality (STAR, HEDIS , etc.) and reduce pharmacy… more
    Elevance Health (11/16/24)
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  • Clinical Nurse, Federal Employee Program…

    Blue KC (Workman, MN)
    …health needs through communication and available resources to promote member safety, quality of care and cost-effective outcomes. + Completes complex and disease ... culturally sensitive way. Uses standardized tools to complete assessments addressing clinical support and social determinants of health needs. + Conducts… more
    Blue KC (11/05/24)
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  • Clinical Quality Program Consultant

    Elevance Health (Miami, FL)
    **Be Part of an Extraordinary Team** **Title** : Clinical Quality Program Consultant **Location:** Candidates must reside within 50 miles or 1-hour commute each ... WFH 3-4 days/week **Build the Possibilities. Make an Extraordinary Impact.** The ** Clinical Quality Program Consultant** is responsible for serving as a… more
    Elevance Health (11/16/24)
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  • Clinical Quality Program Specialist

    Elevance Health (KS)
    …must reside within 50 miles of our Olathe or Topeka PulsePoint. The ** Clinical Quality Program Specialist** is responsible for supporting projects and assisting ... compliance of corporate Quality Improvement (QI) work plans. + Supports Clinical Quality Program with maintaining effective documentation to meet regulatory… more
    Elevance Health (11/14/24)
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  • Systems Analysis Advisor

    The Cigna Group (Nashville, TN)
    … proactive process, which is performed via SSIS, Active Batch Jobs and the HEDIS Quality Engine (currently Cotiviti). + Supports annual HEDIS Regulatory ... process, which is performed via SSIS, Active Batch Jobs and the HEDIS Quality Engine (currently Cotiviti). + Provides quality assurance to ensure accurate … more
    The Cigna Group (11/13/24)
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  • Senior Medical Management Nurse - VCHCP

    Ventura County (Ventura, CA)
    …two (2) years of full-time experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review. NECESSARY SPECIAL REQUIREMENTS ... Utilization Management and tasks related to Healthcare Effectiveness Data and Information Set ( HEDIS ) as well as writing reports and analyses in line with the… more
    Ventura County (11/12/24)
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  • Behavioral Health Clinical Quality

    Elevance Health (Seven Fields, PA)
    …+ Performs monthly, quarterly, annual and ad hoc medical record reviews such as HEDIS and CPG compliance. + Conducts quality of care investigations and using ... Fields, PA; Hermitage, PA Responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO,...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (10/04/24)
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  • Senior Manager , Practice Innovation

    University of Virginia (Charlottesville, VA)
    …stakeholders to develop relevant in-person and online educational trainings on priority HEDIS quality measures, complex diagnosis documentation for improved risk ... quality metric performance. + Maintains thorough knowledge and understanding of the HEDIS quality measures, their nuances and the specifications to adequately… more
    University of Virginia (11/07/24)
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  • Manager Quality and Patient Safety

    Penn Medicine (Bala Cynwyd, PA)
    …events. This position is accountable for facilitating improvement in the areas of clinical quality and patient safety, patient satisfaction and clinical ... include Princeton, Cape May & Somers Point)** Summary: The Quality and Patient Safety Manager participates in...operations. Responsibilities: + Facilitate improvement in patient experience, clinical quality and operations + Serves as… more
    Penn Medicine (09/27/24)
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