- Commonwealth Care Alliance (Boston, MA)
- …of contact for BH providers, promoting alignment with CCA's mission and supporting high- quality , coordinated care for members. In this role, the Program Manager acts ... Clinical teams to ensure a seamless provider experience and consistent delivery of quality care. The BH Provider Engagement Program Manager reports to the Director… more
- Commonwealth Care Alliance (Boston, MA)
- …data analysis, to ensure delegated entities meet contractual, regulatory, and quality standards that optimize member outcomes and operational efficiency. This ... improvement strategies. - Support broader organizational efforts to drive performance on HEDIS and STAR measures. - Schedule and facilitate regular meetings, virtual… more
- US Tech Solutions (Newark, NJ)
- …contract with potential extends or Convert** **Job Description:** + The HEDIS Nurse Auditor is responsible for conducting quality audits related to state ... audits, HEDIS measures, and quality -related complaints and referrals. + This role also supports...preferably in the healthcare industry. + **Active New Jersey Registered Nurse ( RN ) License required.**… more
- Centene Corporation (Springfield, IL)
- …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
- UPMC (Pittsburgh, PA)
- …outside of the realm of Treatment, Payment, or Operations are appropriately logged. + Registered nurse with BSN. + Minimum of 2 years experience working as ... Health Plan has an exciting opportunity for a Sr. HEDIS Coordinator position in the Quality Improvement...needed. + Adhere to the UPMC Health Plan HIPAA Compliance Guidelines. + Ensure that HIPAA standards are met… more
- Molina Healthcare (OH)
- …+ Nursing License ( RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested ... within the department and/or collaboratively with other departments. Please include any HEDIS / Quality experience on your resume. This experience is important for… more
- InGenesis (Fremont, CA)
- InGenesis is seeking an Urgent Care Registered Nurse to join our team in support of our client. In this essential role, you will collaborate with physicians and ... care for a diverse, often underserved population. As an urgent care registered nurse and physician extender, you'll assess symptoms, coordinate care,… more
- Centene Corporation (Surfside Beach, SC)
- …in South Carolina, (2) have a pediatric background, and (3) an active RN license.** Additional Details: * Department: MED- Quality Improvement * Business Unit: ... supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk...compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for… more
- CenterWell (North Charleston, SC)
- …excellence **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) without restriction in applicable state + ... caring community and help us put health first** The Quality RN Professional responsible for the development,...+ Proven work experience as a HEDIS Nurse or similar role in healthcare quality … more
- CenterWell (Orlando, FL)
- …excellence **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) without restriction in applicable state + ... independent determination of the appropriate courses of action. The Quality RN Professional collaborates with market leadership,...+ Proven work experience as a HEDIS Nurse or similar role in healthcare quality … more
- CenterWell (New Smyrna Beach, FL)
- …operational excellence **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) without restriction in Florida + 5+ ... us put health first** The Stars Improvement Clinical Professional ( RN ): + Collaborates with market leadership, and quality...+ Proven work experience as a HEDIS Nurse or similar role in healthcare quality … more
- Humana (Gainesville, FL)
- …operational excellence **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) without restriction in Florida + 5 ... cold calling to the in-network providers to establish working relationships + Quality /clinical management and population health + HEDIS and Stars performance… more
- Molina Healthcare (Tucson, AZ)
- …audits, data analysis and quality improvement surveys and state/federal quality compliance activities. Contributes to overarching strategy to provide safe, ... in a managed care setting, or equivalent experience * Registered Nurse . License must be active and...experience. * Knowledge of Healthcare Effectiveness Data Information Set ( HEDIS ) and National Committee for Quality Assurance… more
- Community Health Systems (Naples, FL)
- Join us as a ** Registered Nurse ( RN ) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an ... authorizations, and partners with providers and staff to drive compliance with utilization policies. The UR Nurse ...patient-centered service and continuous improvement. **Licenses and Certifications** + RN - Registered Nurse -… more
- Molina Healthcare (New Haven, CT)
- …. Clinical experience is needed for positions that are focused on Accreditation, Compliance , HEDIS Interventions, Potential Quality of Care issues, and ... strong knowledge in risk adjustment programs and processes, data acquisition processes, HEDIS and quality performance management across all LOBs. Some… more
- Centene Corporation (Topeka, KS)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... deficiencies impacting plan compliance to meet State and Federal standards for HEDIS . + Under general guidance form Senior Quality Practice Advisors and… more
- Cedars-Sinai (CA)
- …Entity** : Cedars-Sinai Medical Center **Job Category** : Compliance / Quality **Job Specialty** : RN **Overtime Status** : EXEMPT **Primary Shift** ... throughout Los Angeles and beyond. **Req ID** : 13147 **Working Title** : RN Quality Improvement Coordinator - Quality Management (Hybrid) **Department**… more
- Ventura County (Ventura, CA)
- …CNA_MOA_2023-2028.pdf (ventura.org) (https://vcportal.ventura.org/CEO/HR/MOA/docs/CNA\_MOA\_2023-2028.pdf) PAYROLL TITLE: Senior Registered Nurse - Ambulatory ... Care DISTINGUISHING CHARACTERISTICS: The Senior Registered Nurse -Ambulatory Care series is distinguished from other nursing classifications in that they are… more
- Centene Corporation (Austin, TX)
- …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 (Fort Myers, FL)
- …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
