- 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 ... all requirements of National Committee for Quality Assurance (NCQA) and regulatory. Applying both business knowledge and technical expertise to supports HEDIS … more
- Centene Corporation (Columbus, OH)
- …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
- Dignity Health (Bakersfield, CA)
- …at a system/national level in the population health space. **Position Summary:** The Manager , Clinical Quality Improvement, is responsible for leading ... that are consistent with the organization's strategic goals. The Manager , Clinical Quality Improvement will...oversight/supervision/management/leadership of clinical and non- clinical quality management staff. - 3 years HEDIS … more
- ChenMed (Fort Myers, FL)
- …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
- BlueCross BlueShield of North Carolina (NC)
- …lieu of degree, 5+ years of experience in related field + Knowledge of DSNP clinical quality improvement operations and HEDIS **Bonus Points** + Strong ... as required to redirect activities and attain objectives. + Developing HEDIS project plans. + Cross-departmental collaboration and stakeholder education. +… more
- Molina Healthcare (OH)
- …programs/processes and member/provider outreach initiatives. + Supports provision of high- quality clinical care and services by facilitating/building strategic ... accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Health Plan Quality Interventions is responsible… more
- Elevance Health (Seven Fields, PA)
- **JR152864 Behavioral Health Clinical Quality Audit Analyst Sr** This role is primarily focused on conducting medical record reviews of facilities and clinics in ... quarterly, annual and ad hoc medical record reviews such as ASAM monitoring, HEDIS and Clinical Practice Guideline (CPG) compliance. + Coordinates site visit… 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
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- **Job Responsibilities** + Oversee functions performed by separate teams including quality strategy, quality vendor management and quality data management + ... a multi\-year strategy in collaboration with organizational stakeholders including + Clinical Operations in each LOB, Pharmacy, Customer Service, Member Outreach,… more
- Elevance Health (Los Angeles, CA)
- …departments to ensure high- quality care to members and achievement of company HEDIS performance. Implements strategies that meet clinical , quality , and ... **Title:** Behavioral Health Provider Quality Manager **Candidates must posses a...engages with BH providers and ensures measurable improvements in clinical and quality outcomes for members. +… more
- LA Care Health Plan (Los Angeles, CA)
- …Minimum of 4 years of Health Services Domain experience required. 3 years of Clinical Care and 3 years of HIE, HEDIS experience preferred. Functional knowledge ... Technical Applications Manager II Job Category: Information Technology Department: IT...Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and… more
- CenterWell (Tampa, FL)
- …the scope of provider relationships across the following areas: + Quality / clinical management and population health + HEDIS and Stars performance + ... Clinical Professional (RN) collaborates with market leadership, and quality improvement team to develop and implement programs designed... nursing experience + Proven work experience as a HEDIS Nurse or similar role in healthcare quality… 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 ... medical terminology, ICD-10, and CPT coding strongly preferred + Understanding of UDS, HEDIS , and NCQA PCMH accreditation quality standards + Excellent verbal… more
- CenterWell (Covington, LA)
- …the scope of provider relationships across the following areas: + Quality / clinical management and population health + HEDIS and Stars performance + ... caring community and help us put health first** The Quality RN Professional/Stars Improvement, Clinical Professional 2... nursing experience + Proven work experience as a HEDIS Nurse or similar role in healthcare quality… more
- CenterWell (Kissimmee, FL)
- …the scope of provider relationships across the following areas: + Quality / clinical management and population health + HEDIS and Stars performance + ... and help us put health first** The Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation... nursing experience + Proven work experience as a HEDIS Nurse or similar role in healthcare quality… more
- CenterWell (Washington, DC)
- …required pharmacy or clinical management systems + Support CMS Stars and HEDIS quality measures for successful clinic performance + Maintain accurate and ... and help us put health first** We are seeking an ambitious and goal-oriented Clinical Pharmacist with over 5 years of experience to join our primary care… more
- Elevance Health (Metairie, LA)
- …for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, ... driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned… more
- ChenMed (Columbus, OH)
- …indicators. + Fosters growth and effectiveness of Pharmacy work teams to meet quality and clinical care standards/ + Assists Pharmacy leadership in ensuring ... we need great people to join our team. The Clinical Pharmacist specializing in Population Health is a skilled...specialty practice, as well as Part D education for HEDIS measures. + Acts as the pharmacy department's representative… more
- CenterWell (Arlington, TX)
- …ensure optimal patient outcomes and company initiatives including but not limited to Quality , HEDIS / STARs, AHCA, financial management and employee and patient ... CenterWell is a subsidiary of Humana, seeking a Primary Care Clinic Manager , that develops and leads implementation for staffing plans, policies and procedures… more
- Centene Corporation (Iselin, NJ)
- …performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS / quality , cost and utilization, etc. + Completes special projects as ... years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.… more
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