- Blue Cross Blue Shield of Arizona (Phoenix, AZ)
- …oversight to areas within the Health Services Division such including utilization management , quality management , case management , medical claims ... utilization management , case management , disease management , and quality management activities....pharmacy management . Specific activities include outcome analysis, HEDIS , dispute resolution, regulatory compliance, care and… more
- UCLA Health (Los Angeles, CA)
- Description The Quality Management Nurse is responsible for conducting comprehensive facility site reviews (FSRs) to ensure compliance with healthcare standards ... staff and Health Plans to facilitate appropriate Health Education opportunities. Additionally, you will performs HEDIS...+ Provide education and training to internal staff on quality management practices and regulatory requirements +… more
- UPMC (Media, PA)
- UPMC Community Care Behavioral Health is seeking a full-time Quality Management Clinician to support the Quality Department in their Southeast ... Management Clinician is responsible for performing functions related to quality management and improvement in compliance with NCQA, HEDIS , URAC, and the… more
- CVS Health (Richmond, VA)
- …of experience with Managed Care - direct patient care , social work, quality improvement or health coaching, preferably in a managed care environment ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading ...practices to implement quality strategies that improve quality and cost of care , member, and… more
- McLaren Health Care (Flint, MI)
- …years' experience performing quality management activities in a managed care organization, including HEDIS , NCQA, including at least two (2) years' ... Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent...( HEDIS ) process. Facilitates the delivery of medical care in a cost efficient and quality … more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Occasional travel as needed About Us Covenant ... serving as a clinical resource and consultant to the health care team. The RN Care... CARE COORDINATOR II ID 4246987 Facility Covenant Medical Management Department Name QUALITY MANAGEMENT… more
- Sharp HealthCare (San Diego, CA)
- …and direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan Chief Medical Officer. To ... medical issues and departmental responsibilities. Assists in monitoring, reviewing, and evaluating the quality of health care services provided and the… more
- Elevance Health (Baton Rouge, LA)
- …3 years experience in quality improvement and/or behavioral health , risk management and/or utilization review in a managed care setting as well as ... + Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company...as HEDIS and CPG compliance. + Conducts quality of care investigations and using criteria… more
- Sharp HealthCare (San Diego, CA)
- …the continuum of care foundation for our NCQA required population health management program. Additionally, this position provides the representation of ... medical issues and departmental responsibilities. Assists in monitoring, reviewing, and evaluating the quality of health care services provided and the… more
- Providence (WA)
- …gaps, and areas for improvement. + Collaborate with various internal departments ( care management , customer service, outreach, product, sales, marketing, etc.) ... in program planning, development, and evaluation **Preferred Qualifications:** + Experience in quality management principles, tools, and techniques + 5 or more… more
- AmeriHealth Caritas (Washington, DC)
- **Role Overview:** Provide organizational leadership in the operational areas of care management , utilization review, appeals, quality improvement and ... provision of quality and clinically sound behavioral health care services to all members by...;Works closely with a multidisciplinary team to ensure behavioral health management and quality … more
- CVS Health (Tallahassee, FL)
- …DSNP/MMP and other complex health populations to optimize risk adjustment, clinical quality , and care management . * Actively participate in meetings and ... with the Behavioral Health , Pharmacy, Member Outreach, Care Management , National Quality ...multiple stakeholders. * Help achieve or exceed all applicable HEDIS , Stars and local state performance targets and goals… more
- CVS Health (Trenton, NJ)
- …Collaborate closely with internal teams, including clinical and operational leadership, value-based care , quality management teams and provider relations ... feedback, and support to facilitate their success. + Data Management and Reporting: Utilize data management systems... quality . Support population health and health equity initiatives to improve care gap… more
- CVS Health (Lansing, MI)
- …Collaborate closely with internal teams, including clinical and operational leadership, value-based care , quality management teams and provider relations ... feedback, and support to facilitate their success. 7. **Data Management and Reporting** : Utilize data management ... quality . Support population health and health equity initiatives to improve care gap… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- …activities as necessary. Participates in selected committees. Participates in Service Quality Improvement/Performance Improvement, and Quality Management ... and understanding of compliance with expected clinic operational and quality metrics (SAIL, HEDIS , etc. An integral...is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). Qualifications To qualify… more
- Molina Healthcare (Kenosha, WI)
- …and regulatory changes. + Develops policies and procedures as needed. + Participates in Quality Management and Health Education programs including, but not ... limited to, NCQA Accreditation, HEDIS , and Disease Management programs company wide....as a Pharmacist, including at least 3 years in health care delivery. + 2+ years of… more
- Molina Healthcare (Las Vegas, NV)
- …in healthcare with a minimum of 2 years' experience in health plan quality management improvement, managed care , or equivalent experience + Demonstrated ... collaboration with quality leadership with implementation of Health Plan quality program management ...Health Administration, Social Work, or related field + HEDIS reporting or collection + CAHPS improvement experience +… more
- Pacific Medical Centers (Renton, WA)
- …to the Department of Defense and its contractors. Provides support for the quality management program. Providence caregivers are not simply valued - they're ... dictionary entries, and plan benefits and exclusions. Assists with health plan utilization management reporting for the...Degree in a related field, or equivalent experience in Health Care Business Administration as required by… more
- ChenMed (St. Petersburg, FL)
- …hospitalist works for ChenMed or not). + Responsible for assessment, diagnosis, treatment, management , education, health promotion and care coordination and ... to function both independently and in collaboration with other health care professionals. The CMD will work...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other… more
- Humana (Richmond, VA)
- …years of experience working with quality in a fast-paced insurance or health care setting. + Experience working with healthcare providers. + Comprehensive ... findings or corrective actions. + Tracks and monitors compliance Quality Management Reviews (QMR) reporting requirements and...improvement initiatives measures. + Three (3) years of managed care health plan experience. + Knowledge of… more
