- Elevance Health (St. Louis, MO)
- **Business Information Developer Consultant - HEDIS Analytics** **Location:** This position will work a hybrid model (remote and in office one to two days per ... St. Louis, MO, Wallingford, CT or Louisville, KY. The **Business Information Developer Consultant - HEDIS Analytics** is responsible for developing and executing… more
- CVS Health (Phoenix, AZ)
- …The QM Nurse Consultant is a work at home role. Experienced HEDIS record review nurse will be responsible for obtaining, reviewing, abstracting, and data ... **Position Summary** This is a fulltime Quality Management Nurse Consultant opportunity within Arizona. The working schedule is Monday-...entering medical records utilized for HEDIS (R) supplemental data processes. Candidate must understand the… more
- Highmark Health (Harrisburg, PA)
- …is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office based support to ... PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies opportunities for improvement in value creation, cost control… more
- CVS Health (Tallahassee, FL)
- …more personal, convenient and affordable. **Job Profile Summary:** The QM BH Consultant reviews documentation and interprets data obtained from clinical records or ... document root cause of high utilization of care. The QM BH Consultant develops and implements data-driven strategies/interventions that ensure the delivery of time… more
- Humana (Nashville, TN)
- …and help us put health first** The RN Senior Stars Improvement, Clinical Consultant / Professional executes the overall Medicare Stars Improvement Program within the ... working relationship with the health plan. The RN Senior Stars Improvement Consultant / Professional: + Builds and maintains strong relationships with assigned… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Network Executives, the **Quality and Risk Adjustment - Provider Clinical Consultant (PCC)** works directly with providers to evaluate, recommend, and monitor ... focus on keeping Premera members healthy. The Provider Clinical Consultant will work directly and build relationships with care...is available for documentation and coding best practices for HEDIS and risk adjustment. This role will have a… more
- Penn Medicine (Philadelphia, PA)
- …Philadelphia, PA** **Hours: 8hr Days (HYBRID)** **Summary** : + The Principal Consultant , Strategic Decision Support --Nursing operates within the Penn Medicine with ... data analysis, business intelligence, and strategic consulting. The Principal Consultant provides breakthrough insights that drive decision-making within Penn… more
- Two95 International Inc. (New York, NY)
- Job Title: Sr. Analytics Consultant Job type : Remote Work Type : 6+ Months Contract with extension Rate : $Market /Hour Requirements Job Description: Primary ... Python and R, or similar * Deep familiarity with HEDIS & CMS care quality measures; experience implementing both... & CMS care quality measures; experience implementing both HEDIS and CMS measures using SAS and/or SQL *… more
- Humana (Tallahassee, FL)
- …health first** The Humana Florida Team is seeking a Senior STARS Improvement Consultant / Professional who will work directly with the Stars Improvement Lead to ... critical features of large scale projects. Florida The Senior STARS Improvement Consultant / Professional + Critical thinker who has initiative to manage multiple… more
- 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 each way ... **Build the Possibilities. Make an Extraordinary Impact.** The **Clinical Quality Program Consultant ** is responsible for serving as a liaison with and overseeing… more
- Elevance Health (Sacramento, CA)
- **Wellness Nurse Consultant ** **Sign Bonus: $5000** At **Federal Health Products and Services - FHPS** , a proud member of the Elevance Health, Inc. family of ... the territory/market that they will work in._ The **Wellness Nurse Consultant ** position is responsible for developing and recommending customized, group-specific… more
- UCLA Health (Los Angeles, CA)
- Description As the Medicare Advantage Risk Adjustment Performance Improvement Consultant , you will be responsible for: + Serving as a Subject Matter Expert (SME) for ... offered by the health plan + Act as a consultant and partner to the contracted IPAs + Traveling...Knowledge of HIPAA regulations * Knowledge of Medicare Advantage, STARS/ HEDIS program, and NCQA technical specifications, a plus *… more
- Centene Corporation (Sacramento, CA)
- …a CA State clinical license.** **Position Purpose:** The Clinical Data and Audit Consultant -CA Only is responsible for the clinical content component of all data ... to ensure high-quality tracking and performance of the service teams. The Consultant gathers and analyzes data, creates workflows, coordinates internal and external… more
- CVS Health (Trenton, NJ)
- …and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant position in New Jersey. The working schedule is Monday - Friday, ... + 2+ years of experience using Microsoft Excel **Preferred Qualifications** + HEDIS experience + Managed Care experience **Education** + Diploma RN or Associates… more
- Guidehouse (Atlanta, GA)
- …Trust **What You Will Do:** As an AI/ML Health Data Science Senior Consultant with Guidehouse you will present during meetings, summits, and working sessions with ... + Experience with commercial health datasets, eg, claims, encounters, risk scoring, HEDIS measures, etc. + Knowledge of recent and ongoing public health initiatives… 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 ... utilization management. Reviews and uses the population health improvement plan and HEDIS measures as an identification source and identifies initiatives to support… more
- Stanford Health Care (Palo Alto, CA)
- …external visibility and attention (eg CMS, HealthGrades, US News & World Report, HEDIS , PQRS). **Licenses and Certifications** + None **These principles apply to ALL ... employees:** **SHC Commitment to Providing an Exceptional Patient & Family Experience** _Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing… more
- CVS Health (Tallahassee, FL)
- …calls along with provider education initiatives that supports the development of HEDIS interventions to improve mental health wellness and outcomes. The Behavioral ... to apply appropriate clinical criteria and policies in line with HEDIS , regulatory, and accreditation requirements. This position coordinates behavioral health care… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …to ensure that the enrollee attends a seven (7) day follow up appointment. HEDIS Care Gap Reports - Essential Function: Review of health and wellness reports (ie, ... HEDIS Care Gap Reports), provided by Sunshine Health, which...the CBCIH Regional Coordinator and CBCIH Behavioral Health Care Consultant as needed, or upon request. Documentation - Essential… more
- ChenMed (Philadelphia, PA)
- …and hospital sick days), CG CAHPS and net promoter score (patient experience), HEDIS and clinical gaps closures, and medical cost effectiveness measures. Each PCP ... Act as a health coach, rather than just a consultant for sickness, by helping patients set short and...VIP service, standards of care and quality guidelines, and HEDIS /STARS + Inspire seamless coverage of clinical staff for… more
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