• HEDIS Reviewer

    Centers Plan for Healthy Living (Garden City, NY)
    …Experience Required: A minimum of three (3) years of experience in the health care industry, in HEDIS and/or quality improvement. Experience in a managed ... Living (CPHL) under the direction of the Director of Quality Management . Responsibilities include, but are not... care health services environment. Demonstrated knowledge of data collection, medical… more
    Centers Plan for Healthy Living (11/06/24)
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  • HEDIS Quality Management

    Actalent (Des Moines, IA)
    Job Title: HEDIS Quality Management Consultant Job Description Support the Quality Management team during the upcoming HEDIS season by reviewing, ... with HEDIS measure specifications. + Prior work in utilization management , quality management /review, accreditation, or related area preferred.… more
    Actalent (10/29/24)
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  • Clinical Nurse Auditor, HEDIS *Remote

    Providence (Beaverton, OR)
    …Nursing + Dual RN License: Oregon and Washington + 1+ years' experience in Quality Management , Quality Improvement, Utilization Review Auditing + 1+ years' ... New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more...time **Job Shift:** **Career Track:** Nursing **Department:** 5018 HCS QUALITY MANAGEMENT OR REGION **Address:** OR Beaverton… more
    Providence (10/30/24)
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  • Quality Management Nurse Consultant

    CVS Health (Phoenix, AZ)
    …of your health . This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with ... culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position Summary** This is… more
    CVS Health (10/26/24)
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  • Behavioral Health Coordinator, Orange,…

    Community Based Care of Brevard, Inc. (Orlando, FL)
    …identification of enrollees, who may benefit from Sunshine Health behavioral health care management services. Multi-Disciplinary Team (MDT) - Essential ... Review of health and wellness reports (ie, HEDIS Care Gap Reports), provided by Sunshine...past due. Provide follow up and outreach as needed. Quality Management - Essential Function: Review case… more
    Community Based Care of Brevard, Inc. (10/17/24)
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  • Government Business Quality

    Elevance Health (Los Angeles, CA)
    **Government Business Quality Management Health Plan Director-California** **Location** : This position will work a hybrid model (remote and office). The ... CA** Elevance Health PulsePoint location. The **GB Quality Management Health Plan Director**...quality management to direct the clinical quality initiatives, including HEDIS and CAHPS … more
    Elevance Health (10/12/24)
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  • Medicare Advantage Quality Consultant…

    Highmark Health (Harrisburg, PA)
    …with Medicare STARS, Medicaid HEDIS , risk revenue value streams, and population health management **Preferred** + 7 years in a government program setting, ... managed care , primary care management or...Six Sigma, TQI, TQC or other quality management certification + Experience in health plan… more
    Highmark Health (10/24/24)
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  • Quality Improvement Specialist (Hybrid)

    VNS Health (Manhattan, NY)
    …Work Experience: Minimum of three years quality improvement experience in a health plan or health care , setting required Demonstrated leadership ... Triple Aim framework: improving the patient's experience of care (including quality and satisfaction), improving the health of populations, and reducing the… more
    VNS Health (10/15/24)
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  • Clinical Quality Registered Nurse

    Humana (Columbus, OH)
    …+ 2 or more years of Utilization Review (UR), Case Management (CM) or Quality Management ( QM ) experience + Provide coverage in the Eastern Time Zone ... Quality Audit Professional 2 supports the Healthcare Quality Management Team in administering and implementing...millions of people we serve to achieve their best health - delivering the care and service… more
    Humana (11/06/24)
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  • Primary Care Physician

    ChenMed (Philadelphia, PA)
    …FOR OWN PANEL AND CENTER:** + Responsible for assessment, diagnosis, treatment, management , education, health promotion, care coordination and documentation ... to function both independently and in collaboration with other health care professionals. He/she will adhere to...Manages clinical teams to deliver VIP service, standards of care and quality guidelines, and HEDIS more
    ChenMed (09/28/24)
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  • RN Care Coordinator

    Covenant Health Inc. (Knoxville, TN)
    Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 hours per pay period, Day Shift Covenant Medical Group is Covenant Health 's ... direction of Quality Leadership to provide collaborative care management services. Recruiter: Sandra Simmons ||... metrics and available payer resources to assist in care coordination efforts. + Demonstrates knowledge of HEDIS more
    Covenant Health Inc. (10/23/24)
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  • Quality Provider Liaison - Must live…

    CVS Health (Jenks, OK)
    …and Delaware** + Monday-Friday 8am-5pm CST + 3+ years' experience in healthcare or managed care or quality management + 2+ years' experience using personal ... of your health . This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with… more
    CVS Health (10/30/24)
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  • Behavioral Health Clinical Quality

    Elevance Health (Seven Fields, PA)
    …3 years experience in quality improvement and/or behavioral health , risk management and/or utilization review in a managed care setting as well as ... + Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company...as HEDIS and CPG compliance. + Conducts quality of care investigations and using criteria… more
    Elevance Health (10/04/24)
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  • Primary Care Physician

    ChenMed (Cincinnati, OH)
    …hospitalist works for ChenMed or not). + Responsible for assessment, diagnosis, treatment, management , education, health promotion and care coordination and ... to function both independently and in collaboration with other health care professionals. The Lead PCP will...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other… more
    ChenMed (10/26/24)
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  • Senior Medical Director - Sharp Health Plan

    Sharp HealthCare (San Diego, CA)
    …the continuum of care foundation for our NCQA required population health management program. Additionally, this position provides the representation of ... medical issues and departmental responsibilities. Assists in monitoring, reviewing, and evaluating the quality of health care services provided and the… more
    Sharp HealthCare (10/20/24)
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  • Chief Medical Officer / Regional VP Health

    Humana (Stevens Point, WI)
    …strategy for the Health Services Operations, which includes: Care Management for D-SNP, BadgerCare+, and SSI contracts; Quality and Population Health ... strategy for the Health Services Operations, which includes: Care Management for D-SNP, BadgerCare+, and SSI contracts; Quality and Population Health more
    Humana (11/02/24)
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  • Supervisor Provider Relations

    Dignity Health (Bakersfield, CA)
    …'s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and ... containing costs while continually improving quality of care and levels of service. Dignity Health ...managed care . + Strong understanding of Managed Care Operations (ie, Quality , HEDIS ,… more
    Dignity Health (09/28/24)
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  • Regional VP, Health Services

    Humana (Baton Rouge, LA)
    …SNF) according to the Humana Medicare Model of Care . *Participate in Quality Operations including chair Quality Management Committee, complete initial ... . *Oversee regional utilization management and case management for inpatient cases (acute care hospital,...focusing on quality management , utilization management , discharge planning and/or home health or… more
    Humana (10/29/24)
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  • Quality Improvement Specialist, Clinical

    VNS Health (Manhattan, NY)
    …of Education required + Minimum of three years quality improvement experience in a health plan or health care , setting required + Minimum of one year ... improvement program designed to promote and maintain optimal patient care . Manages Health Plans quality ...experience, quality management , practice improvement and compliance preferred… more
    VNS Health (09/04/24)
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  • RN, Manager, Quality & Patient Safety

    Sutter Health (Sacramento, CA)
    quality improvement for the delivery of quality patient care . **Job Description** : **EDUCATION:** Bachelor's: public health , nursing, **CERTIFICATION & ... transformation). Understands applicable quality measures as defined by hedis , integrated healthcare association (iha), cms, accountable care organizations… more
    Sutter Health (10/24/24)
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