- Insight Global (Philadelphia, PA)
- …patient's care needs. The HEDIS nurse focuses solely on using HEDIS measuring criteria to review health plans in accordance with healthcare facility ... Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements Previous HEDIS review experience Active RN License… more
- Providence (WA)
- …facilitation, data analysis and or case review + Experience working as a Nurse supporting a minimum of one HEDIS Audit season **Why Join Providence Health ... specifications for the Healthcare Effectiveness and Data Information Set ( HEDIS ) program + Conduct Audits, which include review...this position include:** + Degree in Nursing + Oregon Registered Nurse License + 5+ years clinical… more
- Actalent (Austin, TX)
- Actalent is currently hiring for Remote HEDIS Nurses ( RN /LPN)! Job Description: + Lead data collection and abstraction for company quality measures, including ... standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS...of Microsoft Applications, including Excel and Access. + Compact RN or LVN/LPN License Why Actalent? + Work with… more
- Actalent (Columbia, SC)
- …results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS and other measure sets in ... and over-reads .Qualification : + 1+ years of Performing HEDIS expereince Mandatory + Having Compact RN OR LPN license is Mandatory If you are Interested… more
- Actalent (Austin, TX)
- …CMS, and CHIPRA * Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom * Review medical records and abstract data ... vendors Additional Skills & Qualifications * Recent experience with HEDIS , NCQA, Quality Initiatives/Standards. * Previous HEDIS ...experience * Advanced knowledge of MS Excel. * Current RN or LPN license Work Environment This position will… more
- Insight Global (Philadelphia, PA)
- …) Strong computer skills Ability to occasionally travel to local providers Previous HEDIS review experience or experience with Utilization Review , Quality, ... Description A client of Insight Globals is looking for HEDIS RNs or LPNs for a partially remote contract...of medical records assigned by a Clinical Quality Lead nurse . Miles will be reimbursed for any travel. Computer… more
- CVS Health (Phoenix, AZ)
- …time. The QM Nurse Consultant is a work at home role. Experienced HEDIS record review nurse will be responsible for obtaining, reviewing, abstracting, ... and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant opportunity within Arizona. The working schedule is Monday- Friday… more
- The Cigna Group (Houston, TX)
- The RN serves as the key contact point for the...as needed 3) 3+ years of experience as a Registered Nurse with experience in internal medicine or ... coordinate and streamline all services offered within Evernorth. The RN will educate the patient on healthcare options, provide...and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- Summary The Registered Nurse is assigned to a designated...the continuum of care. Spinal Cord Serves as the RN Team Leader for a team of patients with the ... and is accountable to the Nurse Manager for the area. The Registered Nurse understands professional practice standards and principals and applies these… more
- Molina Healthcare (Ypsilanti, MI)
- **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must live and have a current active unrestricted RN license in the ... QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Improvement ( Registered Nurse ) contributes to one or more of… more
- Ventura County (Ventura, CA)
- …care services to County employees and their covered dependents. The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing ... amount of supervision commensurate with their experience. PAYROLL TITLE: Senior Registered Nurse - Ambulatory Care AGENCY/DEPARTMENT: Health Care Agency… more
- The Cigna Group (Bloomfield, CT)
- …requires working onsite at providers office. **Experience** : + Current Licensure as a registered nurse , in the state of residence in good standing. + Associates ... knowledge- able to type 35WPM. + Knowledge of utilization review requirements and procedures. + Knowledge of current health...utilization management position (experience can be a combination of LVN/ RN licensure) + Previous HEDIS and/or CMS… more
- Molina Healthcare (NM)
- **_JOB TITLE: Sr. Specialist, Quality Improvement RN ( REGISTERED NURSE )_** **JOB DESCRIPTION** **Job Summary** Molina's Quality Improvement function ... QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality Improvement ( Registered Nurse ) contributes to one or more of… more
- ERP International (Nellis AFB, NV)
- **Overview** ERP International is seeking ** Registered Nurse ( RN ) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military ... by using MTF specific Quality Improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the… more
- Fallon Health (Lawrence, 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
- Molina Healthcare (GA)
- **_JOB TITLE: Program Manager: HCS, Clinical Program Design, REGISTERED NURSE_** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and ... present to varying stakeholder audiences._ + _3+ years regulatory/contract requirements review and analysis experience including clinical or case management program… 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
- CVS Health (Trenton, NJ)
- …convenient and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant position in New Jersey. The working schedule is Monday - ... Friday, 8am - 5pm EST. Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from… 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 ... is the territory/market that they will work in._ The **Wellness Nurse Consultant** position is responsible for developing and recommending customized, group-specific… more
- The Cigna Group (Birmingham, AL)
- …in Jefferson, Tuscalossa, Walker or Fayette County **Experience:** * Current Licensure as a Registered Nurse or LVN/LPN, in the state of Alabama in good ... 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
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