- Elevance Health (Nashville, TN)
- Anticipated End Date: 2025-08-04 Position Title: Clinical Quality Director - Stars/ HEDIS Job Description: Clinical Quality Director - Stars/ HEDIS ... 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
- Elevance Health (Walnut Creek, CA)
- …departments to ensure high- quality care to members and achievement of company HEDIS performance. Implements strategies that meet clinical , quality , and ... Anticipated End Date: 2025-08-25 Position Title: Behavioral Health Provider Quality Manager - Northern California Job Description: Title: Behavioral Health… more
- CenterWell Primary Care (North Miami Beach, FL)
- …(RN) represents the scope of provider relationships across the following areas: Quality / clinical management and population health HEDIS and Stars ... clinical nursing experience Proven work experience as a HEDIS Nurse or similar role in healthcare quality...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- Fallon Health (Worcester, MA)
- …among the nation's top health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, ... and LinkedIn. Brief summary of purpose: The Nurse Case Manager (NCM) is an integral part on an interdisciplinary...care coordination, care management and improving access to and quality of care for Fallon members. NCM seeks to… 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
- PacificSource (Springfield, OR)
- …(PMP) or ability to obtain certification within 1 year required. Knowledge: In-depth knowledge of clinical quality measures (eg, HEDIS , CAHPS, and other CMS ... impact and help people? Join PacificSource and help our members access quality , affordable care! PacificSource is an equal opportunity employer. All qualified… more
- CenterWell Primary Care (Longwood, FL)
- …packages. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or ... in other roles based on business need Preferred Qualifications *Experience with HEDIS *Experience with Electronic Medical Records *Previous experience in a geriatric… more
- Community Health Centers of the Central Coast (Santa Maria, CA)
- …- $3,969.00 bi-weekly SUMMARY Under the direct supervision of the Health Center Manager and in-direct clinical supervision of Nursing Administration, the ... Demonstrates cultural sensitivity and competence with patients. Demonstrates adherence to Quality Improvement processes such as Meaningful Use, HEDIS , UDS… more
- CenterWell Primary Care (Las Vegas, NV)
- …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 outcome… 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
- LifePoint Health (Las Cruces, NM)
- …volumes in PCP visits, colonoscopies, cervical cancer screenings, and mammograms. The Quality Practice Manager (QPM) will collaborate with employed practices to ... initiate one-on-one meaningful interactions regarding current performance. Utilize professional, clinical and/or quality improvement experience and expertise to… 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
- ChenMed (St. Petersburg, FL)
- …overall clinical value while engaging physicians to improve clinical quality , efficiency, outcomes, cost effectiveness, and physician/patient satisfaction. ... days), CG CAHPS and net promoter score (patient experience), HEDIS and clinical gaps closures, and medical...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other… more
- Dignity Health (Phoenix, AZ)
- …per assigned territory. - Serves as subject matter expert in network and clinical quality indicatives, MIPS/MACRA, and other various value based arrangements as ... Arizona Care Network (ACN). ACN CPLs report to the Manager of Practice Transformation within the Clinical ...which support our clinicians and their teams on understanding clinical quality measures, network utilization and care… more
