- Molina Healthcare (Long Beach, CA)
- Job Description Job Description Job Summary The Manager , Quality Program Management and Performance oversees and leads activities to maintain compliance with state ... Nursing, Public Health, Health Administration, Social Work, or related field HEDIS reporting or collection CAHPS improvement experience State QI experience Medicaid… more
- Frontier Health (Johnson City, TN)
- Description JOB TITLE Case Manager II SUMMARY: Selected candidates will provide professional case management services using evidence based assessment and treatment ... assist clients in addressing social determinants of health, closing HEDIS gaps, and provide care coordination with internal and...the on-call staff as appropriate may contact the Case Manager . 11. Must be able to safely operate a… more
- Sanofi (Richmond, VA)
- Job Title: Strategic Account Manager - Vaccines Location: US Remote/Field About the Job The Strategic Account Management organization is a highly skilled ... Demonstrated understanding of value-based care models , quality metrics (eg, HEDIS , STAR, CMS), and performance improvement initiatives Proven ability to collaborate… more
- EmblemHealth (New York, NY)
- …oversee ongoing operational execution of quality improvement projects and action plans ( HEDIS , CAPHS, and HOS) to meet corporate business goals for Medicare, ... data-driven strategic plans. *Assist in leading cross-functional teams for collaboration on HEDIS , CAHPS, HOS, Pharmacy, and Enterprise metrics. *Serve as a point of… more
- Healthmap Solutions (Lexington, SC)
- …for those who need us most. Position Summary The Clinical Care Manager is responsible for developing and maintaining long-term relationships with physicians, ... process improvement in provider workflows, Kidney Health Management interventions and HEDIS /STAR measures for identified areas of provider low performance Identify… more
- The Judge Group Inc. (Philadelphia, PA)
- Job Posting: Registered Nurse - Case Manager (Day Shift) Schedule Details Shift: Day, 5x8-hour (08:00-16:30) Block Scheduling: Not available Weekend Requirement: ... Regulatory Compliance CMS CPT coding and billing Department of Health DRG HEDIS measures HIPAA ICD-10 coding NCQA OSHA The Joint Commission standards Workers'… more
- MedStar Family Choice (Washington, DC)
- …Name MedStar Family Choice Job Type Travel Offering Nursing Profession RN Specialty Case Manager Job ID 32984627 Job Title Registered Nurse - Case Manager @ ... End Date 11/10/2025 Duration 13 Week(s) Job Description Job Title: Case Manager Profession: Registered Nurse Specialty: Case Management Duration: 13 Weeks Shift: Day… more
- CenterWell Primary Care (Tampa, FL)
- …across the following areas: Quality/clinical management and population health HEDIS and Stars performance Operational improvements Financial performance and ... state 5+ years of clinical nursing experience Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement Strong knowledge of … more
- CenterWell Primary Care (North Charleston, SC)
- …across the following areas: Quality/clinical management and population health HEDIS and Stars performance Operational improvements Financial performance and ... state 5+ years of clinical nursing experience Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement Strong knowledge of … more
- American Traveler (Washington, DC)
- American Traveler is seeking an experienced RN Case Manager with a DC license and case management or utilization management background for a day shift position. Job ... criteria, care coordination, discharge planning, Milliman/InterQual, and quality measures such as HEDIS and Core Measures, *Must be able to use CPT coding, ICD-10… more
- Regal Medical Group, Inc. (Northridge, CA)
- The Clinical Quality Manager is responsible for ensuring that pharmacy services under their control are cost-effective and meet organizational expectations. This ... monitoring, and evaluating the professional components of pharmacy services. The manager facilitates program development, takes the lead on projects, and oversees… more
- Molina Healthcare (Long Beach, CA)
- …Medicaid eligible members as well as Medication Adherence Programs for STAR, HEDIS and behavioral health medications. *Ensures that adequate staffing coverage is ... and to determine which recommended changes to drug therapy were implemented. *Assists Manager or Director in the collection and tabulation of data for reporting… more
- Elevance Health (Norfolk, VA)
- …medication adherence-related topics to align closely with STARs Ratings and HEDIS quality measures. Assists members with scheduling their preventive test/screenings ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- COMMUNITY HEALTH GROUP (Chula Vista, CA)
- …facility and medical record reviews, Health Effectiveness Data and Information Set ( HEDIS ) file review and clinical oversight, and the quality reporting. Serving in ... as necessary to support the Corporate Quality Department responsibilities including HEDIS -related activities. Assists the Director of Corporate Quality in producing… more
- The University of Miami (Miami, FL)
- …UHealth System at the University of Miami has an exciting opportunity for a Case Manager RN in the Population Health Department. SUMMARY The Case Manager RN ... Supports and performs duties as directed and under the supervision of RN Manager Case Management. Collaborates with Primary Care Providers to develop and execute… more
- Centene Corporation (Salem, OR)
- …perspective on workplace flexibility. **Position Purpose:** Oversee and ensure HEDIS data accuracy and reporting, including investigations, auditing, and improvement ... opportunities. Collaborate with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing… 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 all ... regulatory. Applying both business knowledge and technical expertise to supports HEDIS strategies, goals, and initiatives at corporate and plan-level.; **Work… more
- Centene Corporation (Phoenix, AZ)
- …functional process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities + Manager the ... or Nevada.** **Position Purpose:** Supervise and coordinate team ensure HEDIS data accuracy and reporting, including investigations, auditing, and improvement… more
- CVS Health (Tallahassee, FL)
- …all with heart, each and every day. *APPLICANTS MUST RESIDE IN FLORIDA* The HEDIS manager is accountable for Healthcare Effectiveness Data and Information Set ( ... HEDIS ) health care quality projects and initiatives through direction...Position Summary - Responsible for coordinating, implementing, and executing HEDIS Quality Department specific projects, ensuring consistency with company… more
- Molina Healthcare (Boston, MA)
- …pursuit and collection of medical records and other data in collaboration with other HEDIS staff. * Assists the Manager and Supervisor(s) and / or performs ... **JOB DESCRIPTION** **Job Summary** Molina's HEDIS /Quality Improvement Medical Records Collector will work collaboratively...system retrieval and direct onsite pick up, for the HEDIS projects. **Job Duties** * Under the direction of… more
