- Elevance Health (Nashville, TN)
- Anticipated End Date: 2025-08-04 Position Title: Clinical Quality Director - Stars/ HEDIS Job Description: Clinical Quality Director - Stars/ HEDIS ... quality of life through home-care and community based services. The Clinical Quality Director is responsible for working with the regional head of health care… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …Medical Director of Behavioral Health oversees the inpatient/concurrent review process , care integration efforts, and all levels of behavioral health care ... pivot from a "job" opportunity to an authentic experience! The Medical Director of Behavioral Health is responsible for clinical oversight, clinical leadership, and… more
- Humana (Sterling Heights, MI)
- …of our caring community and help us put health first** The Quality Improvement Director provides strategic leadership for Humana's Michigan Medicaid Quality ... and serves as the local health plan lead for accreditation compliance. The Quality Improvement Director oversees all aspects of the plan's Quality Assurance and… more
- Centene Corporation (New York, NY)
- …with occasional travel to Bedford, NH!** **Position Purpose:** Lead and direct process improvement activities that provide more efficient and streamlined ... Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set ( HEDIS ) performance. + Ensure health plan is compliant and become/remain… more
- Sharp HealthCare (San Diego, CA)
- …conjunction with the Director of PHM/ Medical Management and Quality Improvement Director . + Oversees and mentors Medical Directors and Physician Reviewers. ... programs and work plans. + Assists the Chief Medical Officer and the Quality Improvement Director in creating and maintaining a system that gives feedback to… more
- MVP Health Care (Schenectady, NY)
- …relevant regulatory/accreditation requirements (eg, CMS, NCQA, DOH) + Knowledge of quality improvement including HEDIS , STAR, CAHPS measures is preferred. + ... Medical Director , Clinical Review and Care Integrity 625 State...for everyone - which requires innovative thinking and continuous improvement . To achieve this, we're looking for a **Medical… more
- Sharp HealthCare (San Diego, CA)
- …and Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager. + Participates in the grievance process with the Chief ... in short and long range program planning, total quality management (quality improvement ), and external relationships. Works with all departments of Health Services… more
- Molina Healthcare (Santa Fe, NM)
- … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... medical policies, guidelines and medical criteria. + Assists with training medical director colleagues and nursing staff , including leadership of teaching grand… more
- Blue KC (Kansas City, MO)
- …that partners with multiple stakeholders and business unit leadershipto drive ongoing process improvement to ensure risk adjusted revenue optimization. + ... financial assistance** **Employee discount program** **Job Description Summary:** The Director , Government Programs Risk Adjustment & Audit assumes overall… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- …of compliance with expected clinic operational and quality metrics (SAIL, HEDIS , etc. An integral member of the Interdisciplinary Polytrauma/TBI Team, ... necessary. Participates in selected committees. Participates in Service Quality Improvement /Performance Improvement , and Quality Management activities. Others… more
- Apicha Community Health Center (New York, NY)
- …supporting improvement of patient health outcomes + Support implementation process and data optimization efforts to ensure data is accurate and reliable ... a multidisciplinary staff to meet Population Health and quality improvement goals through projects aligned with the mission of...and statements of work under the guidance of the Director of Population Health Management + Monitor project progress… more
- Adelante (Phoenix, AZ)
- …position will work closely with WIC training Coordinator and WIC operations to implement process improvement and monitor process improvement changes. ... Director of WIC to identify opportunities for quality improvement and oversee performance improvement initiatives. This...degree + Experience in managed care with knowledge of HEDIS and STARS Quality Metrics preferred + Quality Assurance… more
- Trinity Health (Boise, ID)
- …preferred. + Electronic health record (EHR) experience required. + Experience with process improvement or Lean philosophy preferred. **Highlights and Benefits** ... and the highest quality of care. The Quality Performance Improvement , Population Health Team is now hiring for a...initiatives (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …will report directly to their assigned Population Health Manager and the Director of Value-Based Performance Improvement . + The embedded Population Health ... performance meetings with providers/practice admin, Population Health Manager and EHN Director of Value-Based Performance Improvement . + Maintain current… more
- Adelante (Goodyear, AZ)
- … Plans. + Other projects as requested by the Nursing Manager, Quality Improvement Manager, or Director of Quality NON-ESSENTIAL SKILLS AND EXPERIENCE: + ... vaccine). + Perform PPD placement, Flu and COVID testing. + Support referral process as needed per AHC standing orders and procedures. + Develop Self-Management… more
- Elevance Health (Baton Rouge, LA)
- …risk management and/or utilization review in a managed care setting as well as process improvement ; or any combination of education and experience which would ... you make an impact:** + Provides recommendations for quality improvement studies including selection of valid and reliable indicators...annual and ad hoc medical record reviews such as HEDIS and CPG compliance. + Conducts quality of care… more
- Community Health Systems (Naples, FL)
- …who needs a reasonable accommodation for any part of the application or hiring process , contact the director of Human Resources at the facility to which ... **Job Summary** Under the direction of the UR Director /Manager the UR Nurse reviews all admissions for...members, providers, and leadership. Support and focus on performance improvement of the UR KPI's. Ensures proper and accurate… more
- Beth Israel Lahey Health (Wakefield, MA)
- …appropriate drill down queries (SQL based queries) to identify opportunities for improvement . Assures, by data testing, the quality and accuracy of BILHPN's claims ... integrity of data. + Collaborates with other analysts and contributes/leads the process to define appropriate mappings for healthcare terminologies to be displayed… more
- Beth Israel Lahey Health (Stoneham, MA)
- …not adversely impact the provision of optimal patient care. Process Improvement . In conjunction with Practice Medical Director and Practice Administrator ... pre-registration information at the time of scheduling; b) patient registration process ; c) verifying health insurance coverage and demographic information. .… more