• HEDIS Review Nurse

    Actalent (Chicago, IL)
    Job Title: HEDIS Review SpecialistJob Description - Will be calling out to providers and doctors' offices to retrieve medical information and ask any follow-up ... and provider clean-up. - Will be part of the HEDIS team during the Jan-May season. Review ...- need to be done on critical cases. A RN or LPN/LVN responsible for annual patient chart inspection/audit.… more
    Actalent (10/27/24)
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  • Quality Management Nurse Consultant

    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
    CVS Health (10/26/24)
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  • HEDIS Overreader Registered

    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
    Insight Global (10/01/24)
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  • HEDIS Registered Nurse

    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
    Insight Global (10/01/24)
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  • Hedis Nurse - RN Required-…

    Actalent (Dallas, TX)
    …other quality initiatives as necessary Qualifications: - Registered Nurse ( RN ) license. - Experience with HEDIS measures and data abstraction. - Strong ... Description: We are seeking a dedicated and meticulous HEDIS Nurse to assist with the...standards and/or custom or other measure set standards * Review medical records and abstract data for HEDIS more
    Actalent (11/02/24)
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  • Clinical Nurse Auditor, HEDIS

    Providence (Beaverton, 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 ... 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
    Providence (10/30/24)
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  • HEDIS Nurse Chart Abstractor

    Robert Half Accountemps (San Antonio, TX)
    …of patient data and adhere strictly to HIPAA privacy rules and regulations. Requirements + Registered Nurse ( RN ) or Licensed Practical Nurse (LPN) with ... Description We are seeking a quick-thinking and detail-oriented HEDIS Nurse Chart Abstractor who is...the development of new data processes to improve overall HEDIS measures. Responsibilities: + Review and abstract… more
    Robert Half Accountemps (10/19/24)
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  • Consultative Partner HEDIS Nurse

    Corewell Health (Grand Rapids, MI)
    …The HEDIS Record Reviewer performs accurate and efficient medical record review and abstraction for HEDIS reporting to support client critical quality ... follow strict confidentiality of member information. Qualifications Required + ( RN ) - State of Michigan Upon Hire Preferred +...Hire Preferred + 2 years of previous experience with HEDIS Medical Record Review & Abstraction experience… more
    Corewell Health (11/07/24)
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  • Registered Nurse - Outpatient…

    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
    Veterans Affairs, Veterans Health Administration (10/26/24)
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  • Clinical Quality Registered Nurse

    Humana (Columbus, OH)
    …government contract requires US citizenship for this position.** The **Clinical Quality Registered Nurse ( RN )** collects and reviews records, summarizes ... Coordinates case presentations and presents to Patient Safety Peer Review Committee. Audits quality cases for compliance and participates...or more years of clinical nursing experience + Active RN ( Registered Nurse ) license in… more
    Humana (11/06/24)
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  • Registered Nurse - In Home Primary…

    The Cigna Group (Philadelphia, PA)
    The RN Coordinator serves as the key contact point for...as needed 3) 3+ years of experience as a Registered Nurse 4) Proficient level of experience with ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...and participates in patient education and outreach tied to HEDIS initiatives 4. Works to improve access to care… more
    The Cigna Group (10/18/24)
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  • Advanced Practice Registered Nurse

    University of Miami (Miami, FL)
    …this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Advanced Practice Registered Nurse General Internal Medicine ... day/night Saturday and Sunday, when necessary) The Advanced Practice Registered Nurse (APRN) d elivers medical care...of Medicare annual wellness exam documentation + Knowledge of HEDIS Quality Care Gaps - review and… more
    University of Miami (09/14/24)
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  • Quality Improvement ( RN ) - Maternity…

    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
    Molina Healthcare (10/20/24)
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  • Senior Medical Management Nurse - VCHCP

    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
    Ventura County (10/24/24)
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  • LPN or RN Nurse Case Manager (Onsite…

    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
    The Cigna Group (10/10/24)
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  • Clinical Quality Coordinator ( RN )

    Centene Corporation (Trenton, NJ)
    …managed care setting required Experience in a government sponsored managed care program preferred RN - Registered Nurse - State Licensure and/or Compact ... flexibility. **Position Purpose:** Conduct member outreach, provider outreach, and chart review to assess, plan, gather information, and coordinate medical and… more
    Centene Corporation (11/06/24)
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  • RN -Utilization Management

    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
    ERP International (11/02/24)
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  • Nurse Case Manager - Boston - Mileage…

    Fallon Health (Boston, 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
    Fallon Health (10/09/24)
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  • RN - Coordinator

    Carle (Urbana, IL)
    …EDUCATIONAL REQUIREMENTS College Diploma in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License Illinois upon ... RN - Coordinator + Department: HA - Quality Management...accreditation for National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC, and other corporate quality recognition… more
    Carle (11/02/24)
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  • Primary Care Nurse Practitioner/Physician…

    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
    Commonwealth Care Alliance (09/11/24)
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