- Molina Healthcare (Long Beach, CA)
- …requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug ... regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics with regard to patient outcomes,… 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 ... and CMS standards, *Candidates may be floated in rotation according to clinical experience and facility policy, Job Requirements *Active DC RN license required… more
- COMMUNITY HEALTH GROUP (Chula Vista, CA)
- …issues (PQIs), facility and medical record reviews, Health Effectiveness Data and Information Set ( HEDIS ) file review and clinical oversight, and the quality ... analytical support to clinical programs; performs clinical assessments and clinical audits and file review as necessary to support the Corporate Quality… more
- The University of Miami (Miami, FL)
- …on a team for data collection, health outcomes reporting, Medicare Advantage HEDIS clinical audits, and programmatic evaluation. The University of Miami ... faculty or staff position using the Career worklet, please review this tip sheet. The UHealth System at the...of Miami has an exciting opportunity for a Case Manager RN in the Population Health Department. SUMMARY The… more
- Molina Healthcare (TX)
- …Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Mentor entry and Sr. level abstractors. + Works ... lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing...vendors for the medical record collection process. + Assists Manager and Supervisor(s) in training, utilizing the standardized training… more
- Highmark Health (Harrisburg, PA)
- …+ None **Preferred** + Pharmacy **EXPERIENCE** **Required** + 3 years of clinical pharmacy management experience including drug use review activities, ... **JOB SUMMARY** This job will be accountable for the clinical pharmacy operations area, specifically the clinical ...+ Experience with regulatory entities such as CMS, NCQA, HEDIS , DOH etc. **Preferred** + None **LICENSES or CERTIFICATIONS**… more
- Dignity Health (Phoenix, AZ)
- … teams within Arizona Care Network (ACN). ACN CPLs report to the Manager of Practice Transformation within the Clinical Performance Department, and are ... and is a Dignity Health and Abrazo Health (Tenet) physician collaboration. The Clinical Performance Liaison (CPL) is an employee of Arizona Care Network, doing… more
- Molina Healthcare (Savannah, GA)
- …requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug ... regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics with regard to patient outcomes,… more
- Apicha Community Health Center (New York, NY)
- … Manager supports the implementation of strategies to drive clinical transformation toward value-based care delivery and addressing underlying health disparities ... and social determinants of health. The role encompasses analysis and review of trends and projections of key clinical metrics, supporting new program… 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 audits ... and outreach interventions, provider education and outreach interventions, medical record review , focus studies and surveys. + Performs monthly, quarterly, annual… more
- University of Miami (Medley, FL)
- …on a team for data collection, health outcomes reporting, Medicare Advantage HEDIS clinical audits, and programmatic evaluation. The University of Miami ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The UHealth System… more
- Praxis Health (Portland, OR)
- …healthcare clinic, and we're searching for an experienced LPN or MA Care Manager to join our advanced primary care team. This is a high-impact, in-house ... role for a licensed or certified clinical professional with a strong background in care coordination...with centralized PXH/Regence teams to drive performance in: + HEDIS metric tracking + Transitional Care Management (TCM) +… more
- Fallon Health (Berkshire, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Nurse Case Manager (NCM) is an integral part on an interdisciplinary team focused on care… more
- Community Health Systems (Naples, FL)
- …of Nursing, ASN required or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required + Experience in HEDIS , MIPS, PQRS, ACO, STARS ... **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for...programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society… more
- CenterWell (Jacksonville, FL)
- …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals +… more
- Sharp HealthCare (San Diego, CA)
- …process. + Participates in risk management, pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review ... all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends in grievances. Supervises the process for identifying Potential… more
- Sharp HealthCare (San Diego, CA)
- …and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its' Chief Medical Officer. ... in risk management reviews. + Assists in pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review … more
- Trinity Health (Boise, ID)
- …provides education, training, support, and collaboration with primary care clinical teams and providers to support Quality Performance Improvement initiatives ... (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at...and STAR measures. This role reports to the SAMG Manager of Quality Performance Improvement, Population Health. + This… more
- Adelante (Goodyear, AZ)
- …results in the electronic health record. Clinical Collaboration + Collaborate with the clinical team to review and act on Tasks/PTAs sent by providers. + ... conducting thorough assessments of their health needs, performing essential clinical procedures, and facilitating comprehensive care plans. Collaboration with… more
