- Highmark Health (Wilmington, DE)
- …interpret PCP and facility value based reimbursement reports in the areas of National Quality Standards like NCQA, HEDIS , NQF, PQRS etc., and cost and ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This is...utilization management, immunizations, specialty pharmacy, Medicare Stars, and Medicaid HEDIS to strategies designed to promote the Organization's value… more
- AmeriHealth Caritas (Newark, DE)
- …medical management strategies. + Works closely with a multidisciplinary team to ensure behavioral health management and quality management programs are ... of members to optimize appropriate use of behavioral and physical health services. + Participates with Quality Improvement and Medical Excellence in… more