- Actalent (Des Moines, IA)
- Job Title: HEDIS Quality Management Consultant Job Description Support the Quality Management team during the upcoming HEDIS season by reviewing, ... abstracting, and documenting medical records based on NCQA and HEDIS technical specifications. Perform claims research, provider outreach, and create medical record… more
- 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
- Elevance Health (Tampa, FL)
- **Be Part of an Extraordinary Team** **Title** : Clinical Quality Program Consultant **Location:** Candidates must reside within 50 miles or 1-hour commute ... WFH 3-4 days/week **Build the Possibilities. Make an Extraordinary Impact.** The ** Clinical Quality Program Consultant ** is responsible for serving… more
- Centene Corporation (Sacramento, CA)
- …of California and have a CA State clinical license.** **Position Purpose:** The Clinical Data and Audit Consultant -CA Only is responsible for the clinical ... all data collection, account implementations, and audit activities for Clinical Operations to ensure high- quality tracking and...HEDIS , URAC, NCQA compliance, and related reporting for clinical service teams + Interprets clinical data… more
- Humana (Montgomery, AL)
- …partners (PE, MRA, Interop, Clinical Team, etc.) + Instill focus on Stars/ Quality performance + Educate physician groups on HEDIS , Patient Safety and Patient ... community and help us put health first** The Senior Stars Improvement Consultant / Professional executes the overall Medicare Stars Improvement Program within the… more
- Penn Medicine (Philadelphia, PA)
- …with nursing data systems, such as National Healthcare Safety Network (NHSN) and nursing quality data sets such as NCQA- HEDIS and NDNQI. (Preferred) + Relevant ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Defense Health Agency (Lackland AFB, TX)
- **Overview** Nurse Consultant Joint Base San Antonio Time to invest in some new footwear because if you're San Antonio-bound, you'd better _show up in boots_ ! The ... fastest growing city yet has somehow managed to retain a "small town feel." Quality schools and friendly locals (most with military ties) are additional perks to… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …quantitative and analytical skills; becomes a recognized internal subject matter expert and consultant on specific clinical quality and population health ... clinical leadership in making key business and clinical quality decisions; effectively communicates results of...prior experience working with industry standard clinical quality measures and pay-for-performance metrics (eg HEDIS ,… more
- Highmark Health (Buffalo, NY)
- …creation, impact and cost control through the departmental day to day operations and clinical consultant performance in meeting or exceeding the ROI and fiscal ... is responsible for the performance and development of the clinical consultants into highly functioning subject matter experts in...targets as set by Highmark, cost and utilization and quality results in Medicare STARS, Medicaid HEDIS … more
- ChenMed (Philadelphia, PA)
- …teams to deliver VIP service, standards of care and quality guidelines, and HEDIS /STARS + Inspire seamless coverage of clinical staff for each other (eg, ... days), CG CAHPS and net promoter score (patient experience), HEDIS and clinical gaps closures, and medical...his/her assigned center towards being accountable for maximizing overall clinical value by improving clinical quality… 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 (Cincinnati, OH)
- …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
- ChenMed (Detroit, MI)
- …overall clinical value while engaging physicians to improve clinical quality , efficiency, outcomes, cost effectiveness, and physician/patient satisfaction. ... days), CG CAHPS and net promoter score (patient experience), HEDIS and clinical gaps closures, and medical...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other… more
- CenterWell (Jackson, MS)
- …around clinical protocols / disease + prevalence / appropriate levels of clinical quality care + Providing guidance to individual clinicians about patient ... from patients + Ongoing chart review / audit of clinical staff to ensure quality care and...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of… 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
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