• Government Business Quality Management Health Plan…

    Elevance Health (Metairie, LA)
    …management skills. + Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet ... head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement , NCQA accreditation and compliance with… more
    Elevance Health (06/10/25)
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  • Quality Improvement Project Manager

    Centene Corporation (Columbia, SC)
    …requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process , and facilitate project execution, deployment and ... reside in South Carolina **Position Purpose:** Coordinate and monitor quality improvement and organizational projects from inception to closure including National… more
    Centene Corporation (06/13/25)
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  • Senior Medical Director - Sharp Health Plan

    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
    Sharp HealthCare (04/20/25)
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  • Quality Improvement Specialist II

    Centene Corporation (Springfield, IL)
    …Implement process improvements to streamline departmental functions + Assists Director , QI in preparation for audits by regulatory agencies and review ... Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management.… more
    Centene Corporation (06/07/25)
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  • Medical Director - Health Services - Sharp…

    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
    Sharp HealthCare (05/18/25)
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  • Clinical Quality Program Director

    Elevance Health (Columbus, OH)
    …**Clinical Quality Program Director ** is responsible for developing a national quality improvement strategy for a major line of business. **How will you make an ... **Clinical Quality Program Director ** **Location:** Ohio. This role requires associates to...integrates best practices into state programs. + Develops performance improvement plans and oversees the clinical quality improvement more
    Elevance Health (06/05/25)
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  • Medical Director (Ohio)

    Molina Healthcare (Dayton, OH)
    … 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
    Molina Healthcare (06/14/25)
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  • Medical Director , Safety Net Population

    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
    Excellus BlueCross BlueShield (06/07/25)
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  • Medical Director of Primary Care

    ZoomCare (Portland, OR)
    …part of our dedicated, fast-moving team of superstars! ZoomCare is seeking a **Medical Director of Primary Care** to join our team! The Medical Director of ... and implement strategies to improve performance on key quality metrics (eg, HEDIS , STAR Ratings, preventive screenings, and chronic care management). + Monitor and… more
    ZoomCare (04/25/25)
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  • Sr Director Analytics

    Prime Therapeutics (Baton Rouge, LA)
    …new best practice processes, procedures, and templates + Drive transformation and process standardization, execution, and improvement for all analytic work ... our passion and drives every decision we make. **Job Posting Title** Sr Director Analytics **Job Description** The Senior Director Analytics is responsible for… more
    Prime Therapeutics (06/09/25)
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  • Director , Government Programs Risk…

    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
    Blue KC (06/18/25)
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  • Physician - Amputee Medical Director

    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
    Veterans Affairs, Veterans Health Administration (05/15/25)
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  • Population Health Manager

    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
    Apicha Community Health Center (05/22/25)
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  • MA Quality Performance, Pop Health Boise Clinics…

    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
    Trinity Health (04/11/25)
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  • WIC Quality Assurance Specialist

    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
    Adelante (04/11/25)
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  • MA Quality Performance, Pop Health Fruitland/Baker…

    Trinity Health (Fruitland, ID)
    …preferred. + Electronic health record (EHR) experience required. + Experience with process improvement or Lean philosophy preferred. **Highlights and Benefits** ... **:** + This MA role focuses on Quality Performance Improvement within the Population Health area. This position provides...initiatives (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will support the Fruitland Health… more
    Trinity Health (06/09/25)
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  • Registered Nurse

    Adelante (Peoria, 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
    Adelante (06/13/25)
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  • Behavioral Health Clinical Quality Audit Analyst…

    Elevance Health (Seven Fields, PA)
    …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 ... quarterly, annual and ad hoc medical record reviews such as ASAM monitoring, HEDIS and Clinical Practice Guideline (CPG) compliance. + Coordinates site visit dates… more
    Elevance Health (06/17/25)
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  • Utilization Review - Registered Nurse

    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
    Community Health Systems (04/25/25)
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  • Case Manager, RN or Licensed Behavioral Health (SN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …Accountabilities) + Handles all member clinical condition management programs. + Offers process improvement suggestions and participates in the solutions of more ... procedures per corporate and departmental policy. + Implements the Case Management Process per department policies, procedures and guidelines. The process more
    Excellus BlueCross BlueShield (06/10/25)
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