• HEDIS Review Nurse

    Robert Half Accountemps (San Antonio, TX)
    …improvement opportunities. + Efficiently navigating multiple documentation systems to support HEDIS / Star measures and responding to quality -related inquiries ... Nurse, you will play a pivotal role in enhancing healthcare quality through detailed review and analysis...+ Reviewing and collecting data from medical records for Star / HEDIS opportunities, ensuring close monitoring and gap… more
    Robert Half Accountemps (02/29/24)
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  • HEDIS Project Coordinator (Remote)

    CareFirst (Baltimore, MD)
    …record retrieval, and comprehensive cleanup of provider data to bolster healthcare operations, compliance, and quality enhancement initiatives. **ESSENTIAL ... member experiences, health outcomes, and ensure that CareFirst performs as a four- star health plan. This role operates in a fast-paced, collaborative, and iterative… more
    CareFirst (03/26/24)
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  • Director, Clinical Quality

    Honor Community Health (Pontiac, MI)
    …Set ( HEDIS ), Centers for Medicare and Medicaid Services - HEDIS Star rating program, Patient-Centered Medical Home (PCMH) certification standards, ... ) + Centers for Medicare and Medicaid Services - HEDIS Star rating program + Patient-Centered Medical...improvement and risk management Eg The Certified Professional in Healthcare Quality (CPHQ) and Certified Professional in… more
    Honor Community Health (03/14/24)
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  • Risk Adjustment and Quality Measure Analyst

    Universal Health Services (Reno, NV)
    …with emerging trends and technologies in risk adjustment, healthcare analytics, quality measure reporting, and HEDIS measures. EEO Statement All UHS ... Responsibilities Job Summary: The Risk Adjustment and Quality Measure Analyst possesses a deep expertise in...a deep expertise in CMS Medicare Advantage Risk Adjustment, STAR Measure reporting, and HEDIS reporting oversight.… more
    Universal Health Services (03/29/24)
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  • Clinical Quality Program Manager II (Cahps)

    LA Care Health Plan (Los Angeles, CA)
    …Required: At least 5 years experience in a health plan specializing in healthcare quality , informatics, QI initiatives and analytics. Experience in implementing ... to quality excellence in Centers for Medicare and Medicaid Services (CMS) Five- Star Rating System and Marketplace Exchange Quality Rating Systems (QRS). The… more
    LA Care Health Plan (01/10/24)
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  • Prospective Program Solutions & Performance…

    The Cigna Group (Bloomfield, CT)
    …CMS Risk Adjustment and HCC coding process and quality including Medicare Star Ratings and HEDIS + Strongly preferred experience with EMR implementations, ... needs identified. + Function as a Risk Adjustment and Quality SME to support engagement with market and matrix...programs, visit Life at Cigna Group . **About Cigna Healthcare ** Cigna Healthcare , a division of The… more
    The Cigna Group (02/14/24)
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  • LPN/LVN or RN Value Based Care Nurse- Mobile, AL…

    The Cigna Group (Mobile, AL)
    …and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR / CAHPS performance measures. Develop and maintain ... monitor and evaluates options and services in order to facilitate appropriate healthcare outcomes for customers. **Responsibilities:** + Identifies Quality gaps… more
    The Cigna Group (03/26/24)
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  • Quality and Value Clinical Specialist LPN…

    AdventHealth (Altamonte Springs, FL)
    …and understanding of CDI, RAF and HCC coding . Knowledge and understanding of HEDIS and CMS Star rating measures **EDUCATION AND EXPERIENCE REQUIRED:** . ... healthcare experience . Primary care office experience . Quality programs experience **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . Licensed Practical… more
    AdventHealth (03/22/24)
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  • Practice Transformation Specialist

    Apex Health Solutions (Houston, TX)
    …Adjustment Coder (CRC) Certified Professional Coder (CPC) Certified Professional in Healthcare Quality (CPHQ) Licensed Vocational Nurse (LVN) Registered Nurse ... years of medical practice management, clinical program development, clinical transformation, healthcare quality analytics and/or quality improvement Minimum… more
    Apex Health Solutions (03/16/24)
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  • Regional Practice Manager

    VIP Care (Mobile, AL)
    …(ie: data mining relevant to appointments, referrals, etc.) + Assist with closing identified HEDIS gaps and achieving specified Star measures + Work with the ... a reliable team that shares their mission of providing 5- star service that always puts patient care and outcomes...healthy. Be part of a team that is transforming healthcare one patient at a time. We take great… more
    VIP Care (03/12/24)
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  • Health Advocate- Call Coordinator, Healthy…

    CVS Health (Springfield, IL)
    …Advocate p rovides support for Healthcare Effectiveness Data and Information Set ( HEDIS ) quality initiatives by performing the following: + Work on one or ... outbound calls to members who would benefit from designated services including healthcare visits/ screenings , vaccination, or medication refill. + Effective capture… more
    CVS Health (03/10/24)
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  • RN Value Based Care Nurse (Onsite at Providers…

    The Cigna Group (Philadelphia, PA)
    …and manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a ... process to ensure all customers in participating provider practices meet all quality metrics. Responsible for coordinating the delivery of cost-effective, quality more
    The Cigna Group (01/18/24)
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  • Population Health Strategy Manager

    Healthfirst (New York, NY)
    …help the organization achieve top quality performance on key indicators like HEDIS , QARR, and Medicare Advantage Star ratings. The Manager of Population ... coaching, or team lead experience. Experience leading cross-functional work groups Healthcare experience associated with population health outcomes, quality more
    Healthfirst (03/09/24)
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  • Director - Pharmacy Ambulatory Care Programs

    Stanford Health Care (Menlo Park, CA)
    …with Federal and State laws, regulations, standards, TJC, OSHA, CABOP, CMS Star Measures, HEDIS , and departmental policies and procedures. + Administers ... opportunities to optimize patient health outcomes and contribute to Stanford Healthcare 's overarching performance and priority goals. **This is a Stanford Health… more
    Stanford Health Care (03/11/24)
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  • ACO Nurse Case Manager - 1x/week in Boston/Quincy…

    Fallon Health (Waltham, MA)
    …requirements and Program policies and processes + Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member education, ... and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers equitable, high- quality coordinated care and is continually rated among the nation's top… more
    Fallon Health (03/01/24)
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  • Clinical Office Manager

    VIP Care (Cocoa, FL)
    …building their careers with a reliable team that shares their mission of providing 5- star service that always puts patient care and outcomes first. At VIPcare, it's ... healthy. Be part of a team that is transforming healthcare one patient at a time. We take great...and clinical role and is responsible for providing 5 Star Service in assisting physicians in the management of… more
    VIP Care (03/14/24)
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  • Nurse Practitioner/APRN

    EasyHealth (Lakeland, FL)
    …Must have license/certification: APRN, Certified Nurse Practitioner + Knowledge of HCC model, HEDIS and STAR quality measures + Effectively communicate with ... technology and compassion. At EasyHealth, we believe in advancing healthcare with a member-first approach. We're shaping the future...with a member-first approach. We're shaping the future of healthcare , one Annual Wellness Visit at a time. About… more
    EasyHealth (03/28/24)
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  • Director Population Health- Accountable Care…

    RWJBarnabas Health (Somerset, NJ)
    …of processes for change control purposes, required + Experience in understanding various HEDIS and Medicare STAR measures and the requirements, required + ... + Minimum three years work experience within a Hospital, Healthcare , or Managed Care Organization, required + Knowledge of...strategy to improve their Medical Neighborhood utilization + Build Quality Improvement plan and work with the Quality more
    RWJBarnabas Health (01/18/24)
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  • Nurse Practitioner - In Home

    EasyHealth (Hanover, NH)
    Elevate Healthcare as a Nurse Practitioner - Transform Patient...adult medicine specialty + Familiarity with HCC model and quality HEDIS and other STAR ... balance with Easy Health's innovative and flexible approach to healthcare . As a Nurse Practitioner at Easy Health, you...in performing comprehensive assessments such as Annual Wellness & Quality Gap Care visits for our members in their… more
    EasyHealth (03/27/24)
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