- Molina Healthcare (MI)
- …Improvement functions (eg, reporting for key performance measurement activities, including HEDIS , state-based measure reporting and medical record review ). + ... QI compliance activities. **Candidates residing in Michigan with SQL, Quality/ HEDIS and Health plan experience are strongly preferred.** **KNOWLEDGE/SKILLS/ABILITIES**… more
- Molina Healthcare (Ypsilanti, MI)
- …Quality Reporting + Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records ... quality strategies that require a component of near real-time clinical decision-making. These activities may include initiation and management...submitted by providers and the annual HEDIS medical record review . The Senior Specialist… more
- Dignity Health (Bakersfield, CA)
- …is remote/work from home** **within California** **.** **Position Summary:** The Manager , Clinical Quality Improvement, is responsible for leading multiple ... for projects that are consistent with the organization's strategic goals. The Manager , Clinical Quality Improvement will oversee the day-to-day management of… more
- Molina Healthcare (GA)
- **_JOB TITLE: Program Manager : HCS, Clinical Program Design, REGISTERED NURSE_** **Job Summary** Molina Healthcare Services (HCS) works with members, providers ... to present to varying stakeholder audiences._ + _3+ years regulatory/contract requirements review and analysis experience including clinical or case management… 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 ... Utilization Management and tasks related to Healthcare Effectiveness Data and Information Set ( HEDIS ) as well as writing reports and analyses in line with the… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …and Provider Network Executives, the **Quality and Risk Adjustment - Provider Clinical Consultant (PCC)** works directly with providers to evaluate, recommend, and ... that focus on keeping Premera members healthy. The Provider Clinical Consultant will work directly and build relationships with...is available for documentation and coding best practices for HEDIS and risk adjustment. This role will have a… more
- University of Virginia (Charlottesville, VA)
- … clinical outcome measures, and optimizing workflows for capture of relevant clinical information. + Engage in periodic review of program data reflecting ... for leading and managing quality improvement initiatives impacting core clinical processes and critical patient care functions. Works collaboratively with… more
- Elevance Health (Hermitage, PA)
- …quarterly, annual and ad hoc medical record reviews such as ASAM monitoring, HEDIS and CPG compliance. + Prepares and sends formal written correspondence in ... and outreach interventions, provider education and outreach interventions, medical record review , focus studies and surveys. + Conducts quality of care… more
- CenterWell (Raleigh, NC)
- …and approved workflow and leaders as needed. Follows established guidelines/procedures.** ** Review and assess provider/member detail HEDIS data (care gap ... and develop practice specific strategies designed to improve Medicare quality measures ( HEDIS ) as well as Part D/Patient Safety and Patient Experience (CAHPS-HOS).… more
- Penn Medicine (Bala Cynwyd, PA)
- …improving workplace safety in the practices. + Responsible for the creation, review , revision and communication of clinical /safety related policies. + Performs ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- The Cigna Group (Bloomfield, CT)
- …manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ... care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinates, monitor and evaluates options… more
- Tufts Medicine (Burlington, MA)
- …business experience. 2. Four (4) years of healthcare management or clinic manager experience working directly with physicians and practice members with a ... in primary care. 2. Experience with and knowledge of HCC/RAF, PCMH, HEDIS /Quality. **Duties and Responsibilities:** The duties and responsibilities listed below are… more
- Fallon Health (Lawrence, MA)
- …rated among the nation's top health plans for member experience, service, and clinical quality. Fallon Health's NaviCare is a program for people age 65 and ... and LinkedIn** **Brief Summary of Purpose:** The Nurse Case Manager (NCM) is an integral part on an interdisciplinary...providers and office staff and may lead care plan review with providers and care team as applicable +… more
- Elevance Health (Los Angeles, CA)
- …for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA ... Information Set ( HEDIS ) improvement action plans, year round medical record review , and over read processes. + Monitors and reports quality measures per state,… 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 ... center, as the true dyad partner to the Center Manager /Center General Manager . Directly supervise, performance manage...VIP service, standards of care and quality guidelines, and HEDIS /STARS + Inspire seamless coverage of clinical … more
- ERP International (Camp Pendleton, CA)
- …communication strategies. * Collaborate with the Healthcare Effectiveness Data and Information Set ( HEDIS ) Clinical Quality Teams on a monthly basis to evaluate ... Population Health Program, including strategic marketing for specific audiences. * Review beneficiary data from DHB and current and previous analytical data… more
- Sea Mar Community Health Centers (Aberdeen, WA)
- …all relative clinic forms, quality/ HEDIS measures, lab and x-ray reports and review of the Patient Manager and Medication confirmation process and any ... month program that prepares students to take the Certified Clinical Medical Assistant (CCMA) test through the National Health...non-compliance should be reported immediately to the supervisor / manager . + Assists providers with GYN exams, I &… more
- Molina Healthcare (NM)
- …of these quality improvements functions: Quality Interventions, Quality Improvement Compliance, HEDIS , and / or Quality Reporting. Quality Intervention / QI ... key quality strategies that require a component of near real-time clinical decision-making. These activities may include initiation and management of interventions… more
- Sharp HealthCare (San Diego, CA)
- …and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its' Chief Medical Officer. ... in risk management reviews. + Assists in pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review … more
- ERP International (Nellis AFB, NV)
- …admissions, including all eligible beneficiaries, to civilian hospitals and notifies Clinical Nurse Case Manager and Patient Administration Element as ... 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
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