- Actalent (Des Moines, IA)
- Job Title: HEDIS Quality Management Consultant Qualifications + RN Compact License + Bachelor's degree in Nursing + Previous HEDIS experience Job ... Description Support the Quality Management team during the upcoming HEDIS season. Review, abstract, and manage 40-50 medical records per day based on NCQA… more
- Actalent (Des Moines, IA)
- …with HEDIS measure specifications. * Prior work in utilization management , quality management /review, accreditation, outpatient clinic setting or ... to paper document abstraction tool, or into company's electronic HEDIS application Ensure Health & Care Management ...current and consistent with the standards pertinent to the Quality Management team Will work through Wellmark… more
- Elevance Health (San Juan, PR)
- …management related to assigned program activities. + Coordinating and completing HEDIS Quality Department specific projects ensuring consistency with company ... Serves as a consultant , educator, and policy changer in the use of HEDIS data and the quality improvement process. + Collaborates with departments and… more
- CVS Health (Phoenix, AZ)
- …care more personal, convenient and affordable. **Position Summary** This is a fulltime Quality Management Nurse Consultant opportunity within Arizona. The ... Consultant is a work at home role. Experienced HEDIS record review nurse will be responsible for obtaining,...limited to member services, provider relations and integrated care management ) to achieve the common goal of improving member… more
- CVS Health (Columbus, OH)
- …and supports the development of HEDIS interventions and initiatives within the Quality Management Team. The QM BH Consultant reviews documentation and ... or internal Aetna departments to obtain additional information for Quality Management audit purposes or coordination of...3+ years' experience in healthcare with a focus on HEDIS and Quality with experience facilitating and… more
- Highmark Health (Harrisburg, PA)
- …exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with other functions ... HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs of each… more
- Humana (St. Petersburg, FL)
- …Professional/ Consultant contributes to the development, implementation, and management of the company's Medicare/Medicaid Five-Star Quality Rating System. ... Stars Improvement, Clinical Professional works directly with provider groups, Management Services Organizations (MSOs) and organizational leaders to impact Centers… 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 ... **Job Title:** ** HEDIS Reviewer** **Location: Remote** **Duration: 5+ months contract**...and complete documentation of required information to meet risk management , regulatory, and accreditation requirements. + The candidate must… more
- Penn Medicine (Philadelphia, PA)
- …with nursing data systems, such as National Healthcare Safety Network (NHSN) and nursing quality data sets such as NCQA- HEDIS and NDNQI. (Preferred) + Relevant ... Philadelphia, PA** **Hours: 8hr Days (HYBRID)** **Summary** : + The Principal Consultant , Strategic Decision Support --Nursing operates within the Penn Medicine with… more
- Two95 International Inc. (New York, NY)
- …SPSS, and/or open-source including Python and R, or similar * Deep familiarity with HEDIS & CMS care quality measures; experience implementing both HEDIS ... Job Title: Sr. Analytics Consultant Job type : Remote Work Type :...of their EMR/EHR and/or claims data to perform data quality checks * Partner with our biostatisticians and data… more
- Elevance Health (Las Vegas, NV)
- …provider. + Supports practice implementation of action plans around population health management , patient satisfaction and quality and cost performance. + ... setting quality and efficiency metrics, population health and care management structures, data analytics and electronic health records preferred. + Proficient in… more
- Centene Corporation (Sacramento, CA)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... a CA State clinical license.** **Position Purpose:** The Clinical Data and Audit Consultant -CA Only is responsible for the clinical content component of all data… more
- Defense Health Agency (Lackland AFB, TX)
- **Overview** Nurse Consultant Joint Base San Antonio Time to invest in some new footwear because if you're San Antonio-bound, you'd better _show up in boots_ ! The ... has somehow managed to retain a "small town feel." Quality schools and friendly locals (most with military ties)...design, implementation and evaluation of population health and disease management programs based on the identified needs of the… more
- Guidehouse (Atlanta, GA)
- …Trust **What You Will Do:** As an AI/ML Health Data Science Senior Consultant with Guidehouse you will present during meetings, summits, and working sessions with ... written and verbal formats to various audiences (including various levels of management and external clients) in a professional business environment. Scope and staff… more
- ChenMed (Philadelphia, PA)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required ... Act as a health coach, rather than just a consultant for sickness, by helping patients set short and...teams to deliver VIP service, standards of care and quality guidelines, and HEDIS /STARS + Inspire seamless… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …that are due, or past due. Provide follow up and outreach as needed. Quality Management - Essential Function: Review case management reports/data, available ... enrollees, who may benefit from Sunshine Health behavioral health care management services. Multi-Disciplinary Team (MDT) - Essential Function: Provide coordination… more
- ChenMed (Detroit, MI)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required ... outcomes and quality improvement processes. + Experience of population risk management or complex chronic disease care management . + History of being… more
- ChenMed (Cincinnati, OH)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...follow-up patients, typical 1.0 PCP FTE slots are 18-21), HEDIS >4, CG CAHPS (patient experience), clinical gaps closures, and… more
- CenterWell (Dallas, TX)
- …relationship environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding ... and monitor the outcomes of utilization review and disease management programs to meet the quality and...collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving… more