- Humana (Columbus, OH)
- …reviews and supports the staff involved in HEDIS hybrid season review. The Quality Compliance Nurse works to gain more information about members ... caring community and help us put health first** The Quality Compliance Nurse helps in...your skills to make an impact** **Required Qualifications** + Registered Nurse ( RN ) license +… more
- Molina Healthcare (Columbus, OH)
- …EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : + Minimum 10 years experience in quality compliance / HEDIS operations, customer service or provider service ... **Job Description** **Job Summary** The AVP, Quality & Risk Adjustment is responsible for leading...plan and executes on interventions that will improve CAHPS, HEDIS and HOS scores. Responsible for monitoring Part D… more
- Actalent (Chattanooga, TN)
- Description: Position Purpose: Lead data collection and abstraction for company quality measures, including HEDIS , CMS, CHIPRA and/or any other custom ... standards * Review medical records and abstract data for HEDIS and other measure sets in compliance ...initiatives as necessary Requirements: MUST HAVE experience working prior HEDIS seasons Must have a current RN … 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
- TEKsystems (Baltimore, MD)
- …experience in HEDIS and overread review is essential for this role. Licenses/Certifications RN - Registered Nurse - State Licensure And/or Compact State ... Description: PURPOSE: The Clinical Medical Review Nurse an RN with clinical experience...experience will report to the Clinical Support Supervisor - HEDIS and be part of the Quality … more
- Centene Corporation (Jefferson City, MO)
- …providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides ... compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for...maintains provider clinical relationship across product lines. + Maintains Quality KPI and maintains good standing with HEDIS… more
- Centene Corporation (Oklahoma City, OK)
- …Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse ( RN ) preferred. Pay Range: $25.97 - $46.68 ... education for HEDIS measures and coding. Supports the implementation of quality improvement interventions and audits in relation to plan providers. Assists in… more
- Molina Healthcare (Columbus, OH)
- …direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. ** Quality Improvement, HEDIS , Healthcare experience ... License ( RN may be preferred for specific roles) + Active, unrestricted Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are… more
- Molina Healthcare (Edinburg, TX)
- …QI compliance activities. **Candidates with experience in a Quality / HEDIS /Clinical setting will receive first consideration. Please identify that ... **Preferred License, Certification, Association** + Certified Professional in Health Quality (CPHQ) + Nursing License ( RN may... may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current… more
- CVS Health (New Albany, OH)
- …expense reimbursement policy. Preferred Qualifications : Oklahoma residency preferred Oklahoma-licensed registered nurse preferred OR be certified as a Certified ... full accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member… more
- System One (Baltimore, MD)
- …Medical Record Retrieval for Risk Adjustment, internal Supplemental Data Audit (PSV) and other Quality and HEDIS related tasks in the off-season #M2 System One, ... Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The...for Supplemental Data, and supporting other needs within the Quality Department. Pay: $37/HR 90% Remote May need to… more
- Centene Corporation (Columbia, SC)
- …workplace flexibility. **Position Purpose:** Lead data collection and abstraction for company quality measures, including HEDIS , CMS, CHIPRA and/or any other ... standards + Review medical records and abstract data for HEDIS and other measure sets in compliance ...assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis,… more
- Molina Healthcare (Louisville, KY)
- … Quality Program Management and Performance is responsible for leading national Quality compliance and program management activities and acting as a national ... Collaborates with MHI HEDIS Operations to provide HEDIS results and other quality information for...standards. **Required Experience** + Minimum 5 years' experience in quality compliance , accreditation (as applicable), quality… more
- Garnet Health (Middletown, NY)
- …and patient quality safety initiatives. This position will also oversee the RN nurse manager, RN coordinators, care coordination managers and value-based ... preferred. Required Certification/Registration: * Current and ongoing New York State Registered Nurse license. * Primary Care Medical Home certification… more
- AdventHealth (Westwood, KS)
- …Data Analysis related to healthcare. **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . Registered Nurse **Preferred qualifications:** . Registered ... measures (including but not limited to ACO, CMS, HEDIS etc) . Support and maintain outreach initiatives and...Answers questions and provides clear instructions to enhance patient compliance and support quality metrics . Maintains… more
- US Tech Solutions (May, OK)
- …Participates in the audit/overead of the medical record collection and review process for HEDIS quality reporting. + Training will be provided prior to the start ... data populated within a data collection tool to support compliance with HEDIS and CMS performance measures....of PHI, HIPAA Privacy and Security Rule **Education:** + RN /LVN with an associate or bachelor degree is preferred… more
- Humana (Oklahoma City, OK)
- …a part of our caring community and help us put health first** The Senior Quality Compliance Professional uses quality compliance and improvement tools ... gaps in care for Oklahoma Medicaid enrollees. The Senior Quality Compliance Professional has proven data analysis...must meet** **one** **of the following requirements:** + Unrestricted Registered Nurse in the State of Oklahoma… more
- CVS Health (Atlanta, GA)
- …- Strong communication skills - Critical thinking skills **Preferred Qualifications** - Registered Nurse - 2 years experience working with Medicaid or ... Management organization is responsible for leading the delivery of Aetna quality and compliance efforts, cross-functional reporting, and cultural transformation.… more
- Centene Corporation (Olympia, WA)
- …**License/Certification:** RN license and Certified Professional in Health Care Quality preferred. Pay Range: $178,500.00 - $338,800.00 per year Centene offers a ... million members. **Position Purpose:** Oversee all related activities for the Quality Improvement functions. Lead and direct process improvement activities for more… more
- Fallon Health (Springfield, MA)
- …related field preferred **License/Certifications:** + Active, unrestricted license as a Registered Nurse in Massachusetts; current Driver's license and reliable ... and Program policies and processes + Knowledge of and compliance with HEDIS and Medicare 5 Star...**Experience:** + 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… more