• 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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  • Principal Clinical Informatics Specialist RN…

    Providence (OR)
    …a broad knowledge and understanding of the trends and changes taking place in health care , including HEDIS Electronic Clinical Data Systems Measurement and ... New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more...**Job Shift:** Day **Career Track:** Nursing **Department:** 5018 HCS QUALITY MANAGEMENT OR REGION **Address:** OR Beaverton… more
    Providence (11/13/24)
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  • Coding Quality Auditor, HEDIS

    Providence (OR)
    …record + 2+ years of HEDIS experience + 2+ years' experience working with quality management / quality improvement in a nursing work environment + 2+ ... **Providence Health Plan is calling a Coding Quality Auditor, HEDIS who will:** + Be...New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more… more
    Providence (11/16/24)
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  • Clinical Nurse Auditor, HEDIS *Remote

    Providence (WA)
    …Nursing + Dual RN License: Oregon and Washington + 1+ years' experience in Quality Management , Quality Improvement, Utilization Review Auditing + 1+ years' ... Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best… more
    Providence (10/30/24)
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  • Quality Management Consultant…

    CVS Health (Tallahassee, FL)
    …This position will require manipulation and analysis of data to support behavioral health initiatives on the quality management team. **Responsibilities ... and review of case and medical records for behavioral health quality activities, including root cause analysis...health **Preferred Qualifications** + Experience with Medicaid managed care + HEDIS experience + Experience working… more
    CVS Health (11/24/24)
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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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  • Quality Management Nurse Consultant

    CVS Health (Trenton, NJ)
    …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 ... our ability to innovate and deliver solutions to make health care more personal, convenient and affordable....convenient and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant position in New… more
    CVS Health (11/21/24)
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  • Manager Clinical Quality Improvements

    Dignity Health (Bakersfield, CA)
    …Clinical Social Worker (LCSW), NP, PA,). - 5 years of Quality Management ( QM ) experience in managed care health plan setting or medical group. - 5 ... management /leadership of clinical and non-clinical quality management staff. - 3 years HEDIS measures...MA), strongly preferred. - Certification in Health Care Quality and Management (CHCQM)… more
    Dignity Health (11/13/24)
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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 (11/14/24)
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  • Behavioral Health Liaison

    CVS Health (Tallahassee, FL)
    health or mental health **Preferred Qualifications** + Experience with Medicaid managed care + HEDIS experience + Experience working with SUD and/or SMI + ... This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world....or internal Aetna departments to obtain additional information for Quality Management audit purposes or coordination of… more
    CVS Health (11/24/24)
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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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  • Behavioral Health Clinical Quality

    Elevance Health (Hermitage, 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...medical record review, focus studies and surveys. + 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 (11/26/24)
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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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