• Quality and Risk Adjustment - Provider…

    Premera Blue Cross (Mountlake Terrace, WA)
    …Provider Network Executives, the ** Quality and Risk Adjustment - Provider Clinical Consultant (PCC)** works directly with providers to evaluate, recommend, ... that focus on keeping Premera members healthy. The Provider Clinical Consultant will work directly and build...This role will have a positive impact on our clinical quality and coding quality more
    Premera Blue Cross (11/13/24)
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  • Medicare Advantage Quality

    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
    Highmark Health (11/14/24)
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  • Quality Management Nurse Consultant

    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
    CVS Health (10/26/24)
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  • Clinical Quality Program…

    Elevance Health (Miami, 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
    Elevance Health (11/16/24)
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  • RN Senior Stars Improvement, Clinical

    Humana (Nashville, TN)
    …community and help us put health first** The RN Senior Stars Improvement, Clinical Consultant / Professional executes the overall Medicare Stars Improvement ... groups and internal partners along with supporting and improving financial and quality performance within the contracted working relationship with the health plan.… more
    Humana (11/13/24)
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  • Quality Management Consultant

    CVS Health (Tallahassee, FL)
    …The QM BH Consultant reviews documentation and interprets data obtained from clinical records or systems to document root cause of high utilization of care. The ... QM BH Consultant develops and implements data-driven strategies/interventions that ensure the...of data to support behavioral health initiatives on the quality management team. **Responsibilities include:** + Support record collection… more
    CVS Health (11/24/24)
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  • Clinical Data Audit Consultant

    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
    Centene Corporation (10/24/24)
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  • Quality Management Nurse Consultant

    CVS Health (Trenton, NJ)
    …care more personal, convenient and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant position in New Jersey. The working ... Requires an RN with unrestricted active license. Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit… more
    CVS Health (11/21/24)
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  • Quality Consultant (Regulatory…

    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
    Stanford Health Care (11/16/24)
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  • Principal Consultant Strategic Decision…

    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
    Penn Medicine (08/31/24)
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  • Nurse Consultant

    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
    Defense Health Agency (11/02/24)
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  • Senior STARS Improvement Consultant

    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
    Humana (11/23/24)
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  • Behavioral Health Liaison

    CVS Health (Tallahassee, FL)
    …data obtained from clinical records or internal systems to apply appropriate clinical criteria and policies in line with HEDIS , regulatory, and accreditation ... evaluates potential quality of care/gap in care issues based on clinical policies and benefit determinations. + Conducts outbound telephone calls to members… more
    CVS Health (11/24/24)
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  • Primary Care Physician

    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
    ChenMed (09/28/24)
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  • Behavioral Health Coordinator, Orange, Osceola…

    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
    Community Based Care of Brevard, Inc. (10/17/24)
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  • Chief Medical Officer, Medicaid

    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
    VNS Health (11/20/24)
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  • Primary Care Physician

    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 (10/26/24)
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  • Market CMO-North Texas

    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
    CenterWell (10/30/24)
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  • Registered Nurse - Operating Room

    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
    ERP International (11/20/24)
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