- UnitedHealth Group (Melville, NY)
- …of Nurse Practitioner or Physician Assistant accredited program Current state RN license if Nurse Practitioner Current NP or PA license Certification ... Who Have Not Previously Participated in this Program Optum is seeking a Nurse Practitioner or Physician Assistant to join our Home-based Medical Care team in… more
- AlohaCare (Honolulu, HI)
- …data based on the data classification assigned to this job title. Required Qualifications: Nurse ( RN , APRN, NP), Psychologist (PhD or PsyD) or related licensed ... functional managers and providers/PCP offices on Quality Improvement and HEDIS /STARS metrics initiatives. Oversees Utilization Management toward an effective… 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
- Catholic Health Services (Melville, NY)
- Overview Position Summary: The Registered Nurse provides safe, direct patient care utilizing the nursing process in the ambulatory setting. The RN provides ... clinical leadership and is a resource for staff. The Registered Nurse must show an uncompromising commitment...staff meetings and huddles as appropriate. + Participates in Hedis , GPRO, and other quality programs as needed +… more
- System One (Baltimore, MD)
- …for quality measures (including HEDIS ). Navigate EMR systems to retrieve and review records. Qualifications + Licensure: RN (required) or LPN; State or ... Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224...Commercial, FEP, and Medicare Advantage Plans, as well as HEDIS -related activities. The role also involves medical underwriting and… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards and ... facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS related activities, Pay for Performance activities, Provider Access and… more
- HCA Healthcare (Salt Lake City, UT)
- …managing high-risk, multi-morbidity patient populations.** **What qualifications you will need:** + Registered Nurse + Graduate of an accredited college of ... Medical Home (PCMH), government programs (CMS), accountable care organizations (ACOs), HEDIS , and experience with payor cost sharing initiatives + Excellent oral… more
- Banner Health (AZ)
- …employment settings by including remote and hybrid opportunities. As a **Licensed Practical Nurse (LPN)** for **Banner Health Plans** , you will be an integral part ... Management Team** . This assignment-based role focuses on independent chart review and clinical assessment. **Key Responsibilities** : + Independently review… more
- Centene Corporation (Topeka, KS)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... field or equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill… more
- University of Southern California (Los Angeles, CA)
- …+ Pref 2 years Experience in an HMO/IPA/Managed care setting Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic Life Support ... major duties of the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate patient status is… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... All Levels + Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist licensure required. + Minimum… more
- Fallon Health (Lakeville, MA)
- …care related field preferred. **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification** : Certification in Case ... and reliable transportation **Experience:** * 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a… more
- ERP International (Barksdale AFB, LA)
- …NP experience after graduation Licensure:** Current, full, active, and unrestricted Registered Nurse license Life Support Certification:** Possess current ARC ... **Overview** ERP International is seeking a ** Nurse Practitioner,** for a Full-Time position supporting **Occupational...deployment status in a private setting. + Conduct pre-deployment review of health record for any conditions that may… more
- Insight Global (Austin, TX)
- …* 1+ yr in care management/ HEDIS /Stars, women's health, or imaging navigation * Active Registered Nurse ( RN ) Compact License and RN License in one ... new program that reviews health risk assessments and supports HEDIS gap closure. In this role, you will conduct...* Minimum of 2+ years' experience working as a Registered Nurse , * 1+ year of experience… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …aspirus.org. Click here (https://www.aspirus.org/about) to learn more. Credentials: Essential: * REGISTERED NURSE LICENSE Position DIRECTOR - SYSTEM CARE ... (CPUR), or Diplomat of American Board of Quality Assurance and Utilization Review Physicians (D-ABQAURP) + Knowledge of HEDIS , MIPS, Core Measures, NCQA.… more
- University of Miami (Miami, FL)
- …Providers supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of ... Medicare annual wellness exam documentation preferred + Knowledge of HEDIS Quality Care Gaps - review and...Knowledge of HEDIS Quality Care Gaps - review and closure preferred + Knowledge of Hierarchical Condition… more
- CenterWell (Morrow, GA)
- …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Quality (CPHQ) or Certification in Health Care Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and ... on coding accuracy and Quality programs such as including HEDIS and Stars. Your Responsibilities As part of a...discover more about what we have to offer, please review our benefits page. Role Designation Hybrid Anchored in… more
- CenterWell (Anderson, SC)
- …to the strategic intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: ... inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice… more
- Good Samaritan (Sioux Falls, SD)
- …quality risk and risk score adjustment programs. Assist with the quality improvement review and audit related to potential quality risk issues and adverse events as ... complete chart reviews, documentation of findings, referral for medical director review and required reporting. Will perform healthcare effectiveness data and… more
