- Frontier Health (Johnson City, TN)
- …guide to assist clients in addressing social determinants of health , closing HEDIS gaps, and provide care coordination with internal and external medical ... Description JOB TITLE Case Manager II SUMMARY: Selected candidates will provide professional...Education: Tennessee Requirements: Bachelor's degree required; degree in behavioral health related area preferred. If the bachelor's degree is… more
- Healthmap Solutions (Lexington, SC)
- … health , for those who need us most. Position Summary The Clinical Care Manager is responsible for developing and maintaining long-term relationships with ... outpatient or hospital setting preferred Prior experience building and managing relationships with health care providers or patients preferred Proof of valid and… more
- Sanofi (Richmond, VA)
- …and objectives, and their position within the healthcare environment including value-based health care , their competitors, and financial levers. Identify and ... network (IDN), with a focus on quality improvement, population health , or care coordination Demonstrated understanding of...or care coordination Demonstrated understanding of value-based care models , quality metrics (eg, HEDIS ,… more
- Molina Healthcare (Long Beach, CA)
- …of experience in healthcare with a minimum of 2 years' experience in health plan quality management improvement, managed care , or equivalent experience ... Job Description Job Description Job Summary The Manager , Quality Program Management and Performance oversees and...QUALIFICATIONS: Advanced degree in Nursing, Public Health , Health Administration, Social Work, or related field HEDIS… more
- CenterWell Primary Care (North Charleston, SC)
- …of senior-focused primary care , one of the largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on ... relationships across the following areas: Quality/clinical management and population health HEDIS and Stars performance Operational improvements Financial… more
- CenterWell Primary Care (Tampa, FL)
- …of senior-focused primary care , one of the largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on ... relationships across the following areas: Quality/clinical management and population health HEDIS and Stars performance Operational improvements Financial… more
- EmblemHealth (New York, NY)
- …promoting advancing the department mission of effectively managing members and improving health outcomes. Serve as the Quality Management liaison for internal and ... oversee ongoing operational execution of quality improvement projects and action plans ( HEDIS , CAPHS, and HOS) to meet corporate business goals for Medicare,… more
- Elevance Health (Norfolk, VA)
- …Title: Pharmacy Technician Job Description: A proud member of the Elevance Health family of companies, CarelonRx (formerly IngenioRx) leverages the power of new ... technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care . Title: Pharmacy Technician II Hours: 12pm - 8:30pm eastern time… more
- The Judge Group Inc. (Philadelphia, PA)
- …Medical necessity assessments Regulatory Compliance CMS CPT coding and billing Department of Health DRG HEDIS measures HIPAA ICD-10 coding NCQA OSHA The Joint ... Job Posting: Registered Nurse - Case Manager (Day Shift) Schedule Details Shift: Day, 5x8-hour...Approximately 25 cases/day Unit Type: MS/MS Tele Core Responsibilities Care Coordination & Discharge Planning Admission criteria evaluation Discharge… more
- Molina Healthcare (Long Beach, CA)
- …staff of a clinical pharmacy outreach service that educates patients and their health care team to optimize medication related healthcare outcomes, ensure ... members as well as Medication Adherence Programs for STAR, HEDIS and behavioral health medications. *Ensures that... care team, including referrals to state plan health care services. *Analyzes and reviews medication… more
- COMMUNITY HEALTH GROUP (Chula Vista, CA)
- …in a clinical and operational role, supports the provision and access to quality health care and member advocacy. RESPONSIBILITIES Upholds Community Health ... potential quality issues (PQIs), facility and medical record reviews, Health Effectiveness Data and Information Set ( HEDIS )...standards and requirements promulgated by the Department of Managed Health Care (DMHC), the Department of … 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
- The University of Miami (Miami, FL)
- …social workers, clinical and non-clinical teams, etc.) and assist with following a documented health care plan assuring continuity of care for the highest ... of Miami has an exciting opportunity for a Case Manager RN in the Population Health Department....across multiple care settings and for multiple physicians/ health care providers or health … more
- AmeriHealth Caritas (Newtown Square, PA)
- …or Business Management + Minimum 5 years of working experience in the health care industry + Minimum 2 years of HEDIS project management and data collection ... skills Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people… more
- Centene Corporation (Salem, OR)
- …all policies and standards **Education/Experience:** Bachelor's degree in Business Administration, Health Care Administration, Health -Related field, or ... one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national… more
- Centene Corporation (Phoenix, AZ)
- … Care Administration or equivalent experience. 3+ years of quality improvement, HEDIS project management or health care related experience. Working ... functional process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities + Manager the… more
- Elevance Health (Atlanta, GA)
- …**Clinical Quality Director** is responsible for working with the regional head of health care management to direct the clinical quality initiatives, including ... **Clinical Quality Director** **- Stars/ HEDIS ** **Location:** Alternate locations may be considered. This...reports. **Minimum Requirements:** Requires BA/BS in a clinical or health care field (ie nursing, epidemiology, … more
- CVS Health (Tallahassee, FL)
- … manager is accountable for Healthcare Effectiveness Data and Information Set ( HEDIS ) health care quality projects and initiatives through direction ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading ...medical facility experience Preferred Qualifications - 3 years managed care experience - 3 years HEDIS supervision… more
- McLaren Health Care (Flint, MI)
- …forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health ... Michigan-based health plan dedicated to meeting the health care needs of each of our...(QPIP). Manages the Healthcare Effectiveness Data and Information Set ( HEDIS ) process. Facilitates the delivery of medical care… more
- Praxis Health (Portland, OR)
- …of medical terminology and managed care . Required Experience + Population health program involvement or leadership + HEDIS metrics tracking and improvement ... and we're searching for an experienced LPN or MA Care Manager to join our advanced primary...healthcare companies in Oregon. We are not "big box" health care , but rather a company of… more
