- CVS Health (Lansing, MI)
- …Integrated Duals Eligible (HIDE) quality program, including regulatory deliverables, HEDIS activities and reporting and other quality improvement activities. Be ... innovative programs and initiatives to improve outcomes. + Manage medical record review and compile reports for both committee presentation and state submission. +… 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
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift About Us Covenant Medical Group employs or manages ... a proud member of Covenant Health! Position Summary: The RN Care Coordinator II is responsible for integrating evidenced...coordination services within the scope of practice as a registered nurse meeting all required standards both… 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
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- …MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE Four (4) years of experience as a Registered Nurse in a position involving supervision, consultation, education or ... training are most aligned with the role. To prepare, review this helpful Interview Preparation Guide to make the...must possess and retain a current license as a Registered Nurse in Connecticut OR hold a… more
- Molina Healthcare (IA)
- …related field or equivalent experience, OR completion of any of the following programs: + Registered Nurse ( RN ) or State Licensed Vocational Nurse (LVN), ... medical records and other data in support of annual HEDIS project management and ongoing review of...OR completion of any of the following programs: + Registered Nurse ( RN ) or State… 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 (Barnstable, MA)
- …care related field preferred. **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification** : Certification in Case ... Fallon Health Pharmacist, referring members in need of medication review based upon Program process o Develops and fosters...**Experience:** * 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… 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
- Blue KC (Kansas City, MO)
- …+ Experience working for a health plan and/or within a provider office + Registered Nurse and/or medical licensure + Knowledge base of clinical standards of ... experts; and influence provider behavior to achieve needed results. The person will review charts, identify gaps in care, and educate providers and offices to ensure… more
- CareFirst (Baltimore, MD)
- …addition to the required work experience. **Licenses/Certifications Upon Hire Required:** + Health Services\ RN - Registered Nurse - State Licensure and/or ... partnering hospital. This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to… 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
- AmeriHealth Caritas (Columbia, SC)
- …Carolina. ;For internal candidates, bordering states may be accepted. ; **Education/Experience:** + Registered Nurse required + 3 to 5 years Managed Care ... In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and, Clinical Practice Guidelines. The… more
- CenterWell (Atlanta, 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
- 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