- Centene Corporation (Topeka, KS)
- …**Kansas City Metro area, KS or MO.** **Up to 25% travel** ** HEDIS knowledge and Data interpretation** **Provider performance** **Position Purpose:** Establishes and ... sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Provides education for HEDIS measures, appropriate medical record… more
- CenterWell (Houston, TX)
- …of our caring community and help us put health first** The Nurse Practitioner, Cardiology applies advanced education and clinical competencies within the cardiology ... specialty to achieve optimal patient outcomes. The Nurse , Cardiology Practitioner works on problems of diverse scope...rare opportunity that allows for work-life balance within the field of cardiology, with working hours M-F, and no… more
- Fallon Health (Lakeville, MA)
- **Overview** **The Nurse Case Manager is covering Lakeville, Acushnet, Fairhaven, Rochester and Mattapoisett and surrounding territory.** **About us:** Fallon Health ... Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Nurse Case Manager (NCM) is an integral part on...Program policies and processes Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member… more
- Centene Corporation (Indianapolis, IN)
- …providers at large IPA and/or group practices. Serves to collaborate with providers in the field , to improve HEDIS measures and provides education for HEDIS ... deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS . Conducts telephonic outreach, while embedded in the providers' offices, to… more
- Centene Corporation (Carson City, NV)
- …plan providers regarding quality initiatives and key quality performance indicators. Shares HEDIS , CAHPS, HOS, Part D and Administrative Operations reports and gap ... providers with existing resources to educate provider practices in appropriate HEDIS (Healthcare Effectiveness Data and Information Set) measures, medical record… more
- CVS Health (Richmond, VA)
- …protocols and practice guidelines Work in partnership with the Senior and Field Educators, and Senior Clinicians to ensure effective programs for provider training, ... and effective action plans to maintain clinical excellence at all times. (eg HEDIS , NPS, RVUs, etc) Understand, articulate and ensure compliance with State Provider… more
- Elevance Health (Atlanta, GA)
- …will make an impact:** + Coordinates specific health coaching as directed by nurse case manager to address objectives and goals as identified during assessment. + ... ways to overcome those barriers. + Coordinates with the nurse case manager to provide feedback on member goal...goal attainment and clinical issues. + Identify and address HEDIS /STARS gaps in care. + Maintains fidelity to the… more
- University of Southern California (Los Angeles, CA)
- …the status and processing of requests received from ambulatory care management nurse . 8. Assesses ongoing discharge planning needs and documents is computer system ... working relationship with care team members, including pharmacy, behavioral health, field team, office staff, and facility staff. 11. Completes Medicare One… more
- Humana (Canton, IL)
- …Tazewell, Vermilion, and Woodford._ + An active, unrestricted, Registered Nurse **(RN)** license, Licensed Clinical Social Worker **(LCSW)** **OR** Licensed ... is higher. **Preferred Qualifications** + Advanced degree in nursing or business health field . + Certified Case Manager (CCM). + Previous experience working in a… more
- University of Miami (Miami, FL)
- …supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of this position ... + Completion of Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of… more
- ChenMed (Largo, FL)
- …and execution of business strategies that increase revenue and quality ratings ( HEDIS /STARS/Clinical Gaps) and support our core model. + Develops protocols and ... in Business or Healthcare Administration or a healthcare related field preferred + Active and good standing Licensed Practical... preferred + Active and good standing Licensed Practical Nurse (LPN) in current state of employment **OR** a… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …and scope of practice requirements for each specific health-related field /specialty, + Maintains confidentiality and conducts information management procedures per ... Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and… more
- UCLA Health (Los Angeles, CA)
- …CPT (II), and HCPCS coding systems + Knowledge of Medicare Advantage STARS/ HEDIS program and NCQA technical specifications + Knowledge of HIPAA requirements, anatomy ... coding software, and EMR systems + Bachelor's degree (healthcare or relevant field ) or equivalent experience/training Preferred: + Six or more years of clinic… more
- Mount Sinai Health System (New York, NY)
- …in project initiatives. **Qualifications** + BA or BS degree minimum, in a relevant field of study; Masters degree preferred. + 7 years minimum, higher preferred, in ... Medicare regulations and related reporting requirements, such as STARS,QARR, MMCOR, MEDS, RAPS and HEDIS is a strong plus. + Experience working in a health plan or… more