- 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
- 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 (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 (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
- 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 (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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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