- 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
- 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
- Elevance Health (Roanoke, VA)
- **Be Part of an Extraordinary Team** **Title** : Business Information Developer Consultant - HEDIS Analytics **Location:** Candidates must reside within 50 miles ... the Possibilities. Make an Extraordinary Impact.** The **Business Information Developer Consultant ** is responsible for developing and executing more complex data… 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
- Humana (Montgomery, AL)
- …community and help us put health first** The Senior Stars Improvement Consultant / Professional executes the overall Medicare Stars Improvement Program within the ... with physician groups and internal partners.. The Senior Stars Improvement Consultant / Professional works via virtual and in-person collaboration with providers… 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
- 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
- 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 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 (Rancho Cordova, 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
- 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
- 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
- Highmark Health (Buffalo, NY)
- …impact and cost control through the departmental day to day operations and clinical consultant performance in meeting or exceeding the ROI and fiscal targets as set ... Highmark, cost and utilization and quality results in Medicare STARS, Medicaid HEDIS and risk revenue government programs. This includes accountability for team… 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
- CenterWell (Dallas, TX)
- …environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation ... others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.… more
- CenterWell (Jackson, MS)
- …environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation ... others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.… more
- Virginia Mason Franciscan Health (Seattle, WA)
- …and analytical skills; becomes a recognized internal subject matter expert and consultant on specific clinical quality and population health measures, data sources ... industry standard clinical quality measures and pay-for-performance metrics (eg HEDIS , NQF, PQRS, MACRA-MIPS, CMS/Joint Commission eCQM, etc.) and… more
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