- Molina Healthcare (Phoenix, AZ)
- …QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Improvement ( Registered Nurse ) contributes to one or more of ... lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing...+ Certified Professional in Health Quality (CPHQ) + Certified HEDIS Compliance Auditor (CHCA) + Registered Health… more
- The Cigna Group (Philadelphia, PA)
- …Responsibilities** : + None **Qualifications** : + Current Licensure as a licensed practical nurse or registered nurse , in the state of residency. in ... utilization management position (experience can be a combination of LVN/ RN licensure) + Previous HEDIS and/or CMS...knowledge- able to type 35WPM + Knowledge of utilization review requirements and procedures + Knowledge of current health… more
- The Cigna Group (Birmingham, AL)
- …available to work onsite at providers office. **Experience:** * Current Licensure as a Registered Nurse , in the state of Alabama in good standing. * Associates ... utilization management position (experience can be a combination of LVN/ RN licensure) * Previous HEDIS and/or CMS...knowledge- able to type 35WPM * Knowledge of utilization review requirements and procedures * Knowledge of current health… more
- Medical Mutual of Ohio (OH)
- …Nursing preferred.Master's Degree a plus. + 3 years clinical experience as a Registered Nurse preferably in a health plan. **Professional Certification(s)** + ... lines of business.** + **Applies clinical expertise to collect HEDIS and/or study data through chart review ...Registered Nurse with current State of Ohio...Registered Nurse with current State of Ohio unrestricted license. +… more
- Centene Corporation (St. Louis, MO)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... field or equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill… more
- Fallon Health (Worcester, MA)
- …related field preferred **License/Certifications:** + Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver's license and reliable ... providers and office staff and may lead care plan review with providers and care team as applicable +...**Experience:** + 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... the continuum of care. Spinal Cord Serves as the RN Team Leader for a team of patients with...devises strategies to improve Healthcare Effective Data Information Sets ( HEDIS ) metrics, clinical reminders, panel access, timely encounter closures,… more
- CenterWell (Spartanburg, SC)
- …of a Nurse Practitioner/ Physician Assistant program + Active, unrestricted Registered Nurse and Nurse Practitioner/Physician Assistant license in the ... caring community and help us put health first** The Nurse Practitioner (NP) or Physician Assistant (PA) working in...and process management protocols. + Meets with RMD to review outcome data, quality management metrics and other metrics,… more
- Commonwealth Care Alliance (Springfield, MA)
- …etc. + Identify and initiate a plan to meet quality, STAR, and HEDIS measures. + Conduct Annual Visits with patients, taking a detailed history, performing ... or hospitalization. Such visits include a detailed history of present illness, review of systems, physical exam, ordering of appropriate studies and tests,… more
- CareFirst (Baltimore, MD)
- …management. **SUPERVISORY RESPONSIBILITY:** This position manages people. **QUALIFICATIONS:** **Licenses/Certifications** : RN - Registered Nurse - State ... Navigators. The candidates must be familiar with MCG and the Concurrent Review process for hospital admissions. The Manager provides support to confirm adherence… more
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