- Healthmap Solutions (Lexington, SC)
- …better health, for those who need us most. Position Summary The RN Clinical Care Manager is responsible for developing and maintaining long-term relationships ... certification (based on role) 3+ years of progressive experience in healthcare services, clinical operations, quality , or care management 3 years of experience… more
- Athari (New York, NY)
- …interventions. *Represents ICM at various meetings and committees as required. *Provides clinical support for the review of Quality -of-Care concerns being ... Care Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight for the Medicare Advantage and...the Quality Management Department, and collaborates with Quality Management on HEDIS , STAR ratings and… more
- Sea Mar Community Health Centers (Tacoma, WA)
- …as they apply to health centers Focus clinic efforts on patient satisfaction, clinical quality measures, HEDIS , and Meaningful Use standards. Provide ... and Clinical Director in daily operations of the clinic. The Nurse Manager oversees clinical and administrative supervision of all the nursing department… more
- Blue Shield of California (Rancho Cordova, CA)
- …management referral support. The CSC Program Manager , Senior will report to the Manager FEP Non- Clinical Operations. In this role you will lead the ... Job Description Your Role The Federal Employee Program (FEP) Clinical Support Coordinator team is responsible for phone, fax, and email intake, outreach and… more
- Hearst (South San Francisco, CA)
- …Allscripts, or payer-side systems). Familiarity with value-based care initiatives and healthcare quality metrics (eg, HEDIS , MACRA, MIPS). Excellent verbal and ... challenge? The First Databank (FDB) is currently seeking a Strategic Account Manager in the Customer Operations department. The Strategic Account Manager … more
- AltaMed Health Services Corporation (Anaheim, CA)
- … clinical care services/programs, which include patient experience, patient safety, HEDIS quality measures, financial goals, etc. The Supervisor also ... clinical care services/programs, which includes patient experience, patient safety, HEDIS quality measures, financial goals, etc. The Supervisor also… more
- CareOregon (Portland, OR)
- …programs with individual regional clinics/clinic systems that support equitable and high- quality clinical outcomes. Works with CareOregon leaders to establish ... results. Establishes organizational policies and initiatives to maximize achievement of CCO quality metrics and risk recapture by clinical partners. Ensures that… more
- FoundCare, Inc. (West Palm Beach, FL)
- …Work the clinical quality manager to track and report clinical performance measures (UDS, HEDIS , CMS, and other benchmarks). Use EHR and quality ... Job Type Full-time Description The Quality Nurse Manager is responsible for overseeing and improving clinical... Manager is responsible for overseeing and improving clinical quality , patient safety, and regulatory compliance… more
- CenterWell Primary Care (Morrow, GA)
- …relationship environment. Knowledge of Medicare guidelines and coverage. Knowledge of HEDIS quality indicators. Additional Information: Guaranteed base salary + ... - based coder to optimize coding specificity. *Follows policy and protocol defined by Clinical Leadership. *Meets with RMD about quality of care, review of… more
- Somatus (Mclean, VA)
- …plan quality programs. + Interface with data support, quality assurance team, HEDIS Quality Manager , and IT to collect data and maintain the various ... physical and mental well-being + Community engagement opportunities + And more! The Clinical HEDIS Coordinator I will perform the functions related to the… more
- Elevance Health (Atlanta, GA)
- ** Clinical Quality Director** **- Stars/ HEDIS ** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and ... and quality of life through home-care and community based services. The ** Clinical Quality Director** is responsible for working with the regional head of… more
- AmeriHealth Caritas (Newtown Square, PA)
- **Role Overview** Manages Healthcare Effectiveness Data and Information Set ( HEDIS ) planning, data collection, quality control, analysis, and reporting to meet ... NCQA submission requirements + Ensures all data sent to HEDIS software vendor has Quality Assurance protocols...knowledge and experience in using member, provider, claims, pharmacy, clinical (supplemental) data and hos this data correlates and… more
- Molina Healthcare (TX)
- …National Over read team, National Training Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Mentor ... **C** **E/KNOWLEDGE, SKILLS & ABILITIES:** + 5 years experience in healthcare Quality / HEDIS specific to medical record review and abstraction + Intermediate… more
- Centene Corporation (Phoenix, AZ)
- …and present results of improvement efforts and ongoing performance measures + Coordinate clinical quality metrics and HEDIS processes and results + ... functional process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities + Manager the… more
- ChenMed (St. Louis, MO)
- …with the development and execution of business strategies that increase revenue and quality ratings ( HEDIS /STARS/ Clinical Gaps) and support our core model. ... need great people to join our team. The Center Clinical Manager (CCM) is an active leadership...operations, which may include but is not limited to: clinical quality , compliance, human resources, patient experience… more
- Sanford Health (Sioux Falls, SD)
- …Day Shifts **Job Schedule:** Full time **Weekly Hours:** 40.00 **Job Summary** The Manager works closely with Health Plan providers and staff to coordinate Pharmacy ... Benefit services and promote quality and cost effective outcomes. Interacts with members and...providers to optimize member services. This position supervises the clinical aspects of Health Plan Pharmacy department operations to… more
- Highmark Health (Harrisburg, PA)
- …**Job Description :** **JOB SUMMARY** This job will be accountable for the clinical pharmacy operations area, specifically the clinical team of pharmacists who ... support the pharmacy operations team. This job will work closely with the clinical pharmacy strategies and other pharmacy strategy teams to execute on the… more
- Providence (WA)
- …+ Develop and implement strategies to improve Medicare Advantage Star Ratings, driving clinical quality indicators ( HEDIS Star metrics), CAHPS, and HOS ... **Description** ** Quality Program Manager - Medicare Advantage...Stars program oversight, including intervention development and implementation for clinical quality (Stars HEDIS ) measures,… more
- Elevance Health (Baton Rouge, LA)
- **JR142090 BH Clinical Quality Audit Analyst Sr** Responsible for participating in on-site quality external audits such as NCQA, AAHC and EQRO, and prepares ... annual and ad hoc medical record reviews such as HEDIS and CPG compliance. + Conducts quality ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Richmond, VA)
- …providing pharmacy support to Medicare, Commercial, and Medicaid providers, focusing on improving quality (STAR and HEDIS ) and cost measures. You will work ... pharmaceuticals to assist contracted providers in achieving cost and quality goals. + Evaluate pharmacy quality program... by staying up to date on STAR and HEDIS measures. + Provider education to support clinical… more
