- Centene Corporation (Jefferson City, MO)
- …quality experience, provider/market partnership or CAHPS experience preferred. **License/Certification:** Registered Nurse ( RN ), Licensed Practical ... **Position Purpose:** Identify market trends and oversee functions of quality improvement programs for HEDIS or CAHPS...teams to ensure successful execution. + Monitor and ensure compliance related to state reporting, HHS and HPMS memos… more
- ERP International (Eglin AFB, FL)
- **Overview** ERP International is seeking a ** Registered Nurse ( RN )** for a full-time position in support of the **Operating Room** at theEglin Hospital, ... achievement of optimal outcomes in relation to clinical care, quality and cost effectiveness. * Ensure compliance ...to include elective, urgent and emergency procedures. The OR nurse will assess, plan, implement, and evaluate nursing care… more
- 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 ... Utilization Management activities and functions by using MTF specific Quality Improvement processes to identify areas for review from...* Must be able to interpret data to ensure compliance with requirements for length of stay, obtain needed… more
- Centene Corporation (Jefferson City, MO)
- …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
- Molina Healthcare (IA)
- …+ Nursing License ( RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested ... and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Analyst, Quality Improvement (QI)… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Senior Quality Compliance Professional works within the Quality Improvement Team. The ... requires an in-depth evaluation of variable factors. The Senior Quality Compliance Professional uses quality ...must meet **one** of the following requirements: + Unrestricted Registered Nurse in the State of Ohio… 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
- Molina Healthcare (New York, NY)
- …and federal/state QI compliance activities. **Experience with health plan quality / HEDIS is important for this position. Please include this 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 (Jackson, MS)
- …assisting Members with scheduling transportation to appointments; reviewing EPSDT and HEDIS data to inform targeted interventions to increase utilization of ... The EPSDT Coordinator identifies Members who are out of compliance with the Bright Futures periodicity schedule. + Generates...open preventive care gaps to prioritize outreach and support quality initiatives for those Members and their PCPs. +… more
- Centene Corporation (Olympia, WA)
- …Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse ( RN ) preferred.Pay Range: $26.50 - $47.59 per ... education for HEDIS measures and coding. Supports the implementation of quality improvement interventions and audits in relation to plan providers. Assists in… more
- Centene Corporation (Olympia, WA)
- …in Behavioral Healthcare field preferred. **For Coordinated Care -** **Washington only** : Registered Nurse ( RN ), Licensed Clinical Social Worker (LCSW), ... Professional Clinical Counselor (CC/LPCC), Chemical Dependency Professional (CDP). **Licenses/Certifications:** Registered Nurse ( RN ) certification, Licensed… more
- Molina Healthcare (Madison, WI)
- …+ Nursing License ( RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested ... and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Specialist, Quality Interventions/… more
- Centene Corporation (Jackson, MS)
- …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 ...coding or data management experience is required. Experience in quality initiatives (including HEDIS project, study analysis,… more
- Dignity Health (Bakersfield, CA)
- …special projects as assigned. **Qualifications** **Minimum Qualifications:** - CA Clinical licensure ( Registered Nurse ( RN ), Licensed Vocational Nurse ... medical group. - 5 years of oversight/supervision/management/leadership of clinical and non-clinical quality management staff. - 3 years HEDIS measures reporting… 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 ... EPSDT services and close gaps in care for Oklahoma Medicaid enrollees. The Senior Quality Compliance Professional has proven data analysis skills and a strong… more
- Molina Healthcare (AZ)
- … management compliance activities. Please make sure to include any healthcare/ HEDIS / quality metric experience on your resume. We are moving quickly to ... improvement, managed care or equivalent experience. * Demonstrated experience with Quality , HEDIS , RA or equivalent. * Demonstrated solid business writing… more
- Molina Healthcare (Flint, MI)
- …+ Nursing License ( RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) + Experience with EPSDT To all current Molina ... collection, reporting and monitoring for key performance measurement activities. **Experience with quality , providers and HEDIS is very important for this… more
- CVS Health (Springfield, IL)
- …development, modeling inclusive behaviors, and proactively managing bias **Preferred Qualifications** + Registered Nurse , preferably in the state of IL + ... the plan to a detailed and supportive oversight of the activities of the Quality team to ensure maximal performance with HEDIS and accreditations. + Serving… more
- Elevance Health (Seven Fields, PA)
- …quarterly, annual and ad hoc medical record reviews such as ASAM monitoring, HEDIS and CPG compliance . + Prepares and sends formal written correspondence ... use disorder (SUD) services. Additional responsibilities may include participating in on-site quality external audits such as NCQA, Department of Human Services, and… more
- University of Miami (Miami, FL)
- …Providers supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of ... preferred + Completion of Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge… more