- Highmark Health (Harrisburg, PA)
- …and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs of each individual ... or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with other functions… 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 ... Consultant is a work at home role. Experienced HEDIS record review nurse will be responsible for obtaining,...tool. + Typical office working environment with productivity and quality expectations. + Professional customer service demeanor a plus… more
- Stanford Health Care (Palo Alto, CA)
- …specific and organizational goals. + Performs, coordinates, and facilitates quality improvement, patient safety activities, and clinical effectiveness ... Health Care job.** **A Brief Overview** Plans, coordinates, monitors, and improves clinical care and services. Leads multiple small to medium scale, service or… more
- Humana (Tallahassee, FL)
- …solutions + Maintain collaborative relationships with internal partners (PE, MRA, Interop, Clinical Team, etc.) + Instill focus on Stars/ Quality performance + ... health first** The Humana Florida Team is seeking a Senior STARS Improvement Consultant / Professional who will work directly with the Stars Improvement Lead to… more
- ChenMed (Columbus, OH)
- …indicators. + Fosters growth and effectiveness of Pharmacy work teams to meet quality and clinical care standards/ + Assists Pharmacy leadership in ensuring ... rapidly expanding and we need great people to join our team. The Clinical Pharmacist specializing in Population Health is a skilled and proactive professional who… more
- ChenMed (Miami, FL)
- …indicators. + Fosters the growth and facilitation of Pharmacy work teams to meet quality and clinical standards of care. + Assists the Director in ensuring ... great people to join our team. The Part D Clinical Pharmacist Manager is a dynamic and experienced Pharmacist...of the formulary. + Acts as a national pharmacy consultant for our physicians regarding patient case inquiries, drug… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …Suitability Assessments receive them in accordance with Florida Statute, provide clinical consultation and support and ensure funding authorization for children in ... enrollee attends a seven (7) day follow up appointment. HEDIS Care Gap Reports - Essential Function: Review of...past due. Provide follow up and outreach as needed. Quality Management - Essential Function: Review case management reports/data,… more
- ChenMed (Richmond, VA)
- …count for 2 slots, follow-up patients, typical 1.0 PCP FTE slots are 18-21), HEDIS >4, CG CAHPS (patient experience), clinical gaps closures, and medical cost ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other… more
- VNS Health (Manhattan, NY)
- …consultant for unusual and difficult medical cases. Participates in the QARR/ HEDIS Quality Improvement Activities and utilization management of the ... health enhancement programs that support the appropriate use of clinical resources in the delivery of consistent high- quality... clinical resources in the delivery of consistent high- quality medical care. + Performs clinical reviews… more
- CenterWell (Dallas, TX)
- …relationship environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding ... and provide medical direction in pursuit of cost effective, quality healthcare. + Plan, organize, manage and supervise the...in the state of desired employment + Experience leading clinical practice operations + Demonstrate a high level of… more
- ERP International (Eglin AFB, FL)
- …healthcare professionals. Facilitate the achievement of optimal outcomes in relation to clinical care, quality and cost effectiveness. * Ensure compliance with ... inter-departmentally, to provide for total needs of the patient. * Act as a consultant and clinical resource for personnel through the use of evidence-based… more
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