- 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
- Fallon Health (Worcester, 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 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 ... of the Health Center Manager , the CSS will oversee the Medical Assistant clinical competency and performance. It is expected that the CSS will mentor, teach, and… more
- CenterWell Primary Care (Las Vegas, NV)
- …quality- based coder to optimize coding specificity. Follows policy and protocol defined by Clinical Leadership. Meets with RMD about quality of care, review of ... environment Knowledge of Medicare guidelines and coverage Knowledge of HEDIS quality indicators Additional Information Guaranteed base salary + quarterly… more
- Somatus (Mclean, VA)
- …physical and mental well-being + Community engagement opportunities + And more! The Clinical HEDIS Coordinator I will perform the functions related to the ... be to analyze and process the information collected and review the applicable medical records and clinical ...programs. + Interface with data support, quality assurance team, HEDIS Quality Manager , and IT to collect… 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
