- Humana (Columbus, OH)
- …clinical reviews and supports the staff involved in HEDIS hybrid season review . The Quality Compliance Nurse works to gain more information about members ... and help us put health first** The Quality Compliance Nurse helps in providing an accurate, timely, and compliant...timely, and compliant abstraction of medical records to meet HEDIS measurement and reporting requirements as outlined by the… more
- Actalent (Iowa City, IA)
- Job Title: HEDIS Nurse Job Description + We...standards and/or custom or other measure set standards * Review medical records and abstract data for HEDIS ... are seeking a dedicated and meticulous HEDIS Nurse to assist with the collection, analysis, and presentation of healthcare data. + The HEDIS Nurse will… more
- Providence (OR)
- …facilitation, data analysis and or case review + Experience working as a Nurse supporting a minimum of one HEDIS Audit season **Why Join Providence Health ... empower them._** **Providence Health Plan is calling a Clinical Nurse Auditor, HEDIS who will:** + Be...specifications for the Healthcare Effectiveness and Data Information Set ( HEDIS ) program + Conduct Audits, which include review… more
- 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 ... in PA or NJ. This is a fully remote position and requires previous HEDIS review experience. This person will be responsible for Quality Check of FDC/ HEDIS … 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
- Providence (MT)
- …using objective specifications for the Healthcare Effectiveness and Data Information Set ( HEDIS ) program + Conduct Audits inclusive of review of outpatient ... **Providence Health Plan is calling a Coding Quality Auditor, HEDIS who will:** + Be responsible for conducting clinical...GED Equivalency + Licensure / Certification: Medical Assistant, Certified Nurse Assistant, or Licensed Practical Nurse +… more
- TEKsystems (Baltimore, MD)
- Description: PURPOSE: The Clinical Medical Review Nurse an RN with clinical experience will report to the Clinical Support Supervisor - HEDIS and be part of ... - Advanced Current knowledge of clinical practices related to HEDIS and Medical Record Review - Advanced...is essential for this role. Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA… more
- System One (Baltimore, MD)
- ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The main duties include conducting ... thorough HEDIS overreads in line with NCQA guidelines. Additional tasks...found. Correct errors identified through over-read process, including a re- review of charts that may contain similar errors. +… more
- Ventura County (Ventura, CA)
- …years of full-time experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must ... Senior Medical Management Nurse - VCHCP Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4591361) Apply Senior Medical Management Nurse -… more
- The Cigna Group (Philadelphia, PA)
- …about their care options and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all requirements 5. Explain test ... and participates in patient education and outreach tied to HEDIS initiatives 4. Works to improve access to care...needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with Microsoft Office… more
- GEHA (Lee's Summit, MO)
- …personalized customer experience, sustained by a nimble and efficient organization. The Nurse Consultant II provides professional nursing care to our members through ... of the member on how to close those gaps, review of clinical history, and review of...and/or clinical and/or plan policy development and management. The Nurse Consultant II will be involved in research and… more
- CenterWell (Lexington, KY)
- …and providing a positive and welcoming environment for all. **Responsibilities:** The Nurse Practitioner (NP) works in our team-based care environment. We are a ... team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder, Referral Coordinator and… more
- CenterWell (New Orleans, LA)
- …a part of our caring community and help us put health first** The Nurse Practitioner (NP) works in our team-based care environment. We are a value-based care ... team consists of doctors, advanced practice professionals, Pharm D, Care Coach Nurse , MA, Behavioral health specialist, Quality based Coder, Referral Coordinator and… more
- The Cigna Group (Harlingen, TX)
- …manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ... can be a combination of LVN/RN licensure) * Previous HEDIS and/or CMS STARs experience a plus * Bilingual...knowledge- able to type 35WPM * Knowledge of utilization review requirements and procedures * Knowledge of current health… more
- Commonwealth Care Alliance (Boston, 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
- Fallon Health (Worcester, MA)
- …Effectiveness Data and Information Set ( HEDIS (R)) and MassHealth Appendix Q review . The clinical nurse analyst will provide clinical expertise and support ... the general direction of the Senior Manager, Clinical Quality, the clinical nurse analyst is responsible for developing and implementing the assigned quality… more
- University of Miami (Miami, FL)
- …patient population + Completion of Medicare annual wellness exam documentation + Knowledge of HEDIS Quality Care Gaps - review and closure + Knowledge of ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Advanced Practice Registered… more
- ERP International (Fallon, NV)
- …Health Program Manager, review and make recommendations as necessary to improve Hedis data. Input data to the DD2766 automated flow sheet and place the form ... **Overview** ERP International is seeking a **Registered Nurse (RN) Health Educator** for a full-time position...applicable to the ambulatory care setting. Assist in the review and revision of clinic standing operating procedures. Perform… more
- InnovaCare (Ponce, PR)
- …record reviews in accordance with the policies and procedures. Performs medical record review in physician's offices of selected HEDIS sample. Performs follow ... passion and customer focus to the business. POSITION DESCRIPTION The Quality Specialist Nurse is responsible for monitoring quality of care and services delivered to… more
- CVS Health (Dallas, TX)
- …accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member ... Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc. * In conjunction with… more
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