- Actalent (Des Moines, IA)
- Remote HEDIS Nurse Consultant Description HEDIS work typically includes requesting records, abstracting/overreading medical records, performing claims ... research, preparing medical records for the NCQA HEDIS Auditor, etc. Abstracts medical record data from practitioner's files to support annual Healthcare… more
- Actalent (Des Moines, IA)
- Job Title: HEDIS Nurse ConsultantJob Description We are seeking a dedicated HEDIS Nurse Consultant to support our annual Healthcare Effectiveness Data and ... HEDIS measure specifications. + Experience in utilization management, quality management/review, accreditation, or outpatient clinic settings. Work Environment… more
- Highmark Health (Buffalo, NY)
- …and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the needs of each individual ... or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with other functions… more
- Humana (Gainesville, FL)
- …calling to the in-network providers to establish working relationships + Quality / clinical management and population health + HEDIS and Stars performance + ... the time and is not fully remote. The Senior Stars Improvement, Clinical Professional (RN) is responsible for the development, implementation and management… more
- ChenMed (Houston, TX)
- …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
- 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 ... the right time. Mission: LA Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents… more
- University of Southern California (Los Angeles, CA)
- …and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care ... forms timely. 12. Completes disposition form for medicare patients timely. + Consultant 1. Demonstrates sound clinical knowledge base regarding CM standards,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …require peer-to-peer discussions with providers regarding UM case review determinations. + Provides clinical expertise on ARD cases, Quality of Care cases, ... Level I Accountabilities) + Leads, develops, directs and implements clinical and non- clinical activities that impact health care quality cost and outcomes. +… more
- ChenMed (Richmond, VA)
- …count for 2 slots, follow-up patients, typical 1.0 PCP FTE slots are 18-21), HEDIS >4, CG CAHPS (patient experience), clinical gaps closures, and medical cost ... acts as a health coach, rather than just a consultant for sickness, by helping patients set short and...compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other… more
- CenterWell (Anderson, SC)
- …around clinical protocols / disease + prevalence / appropriate levels of clinical quality care + Providing guidance to individual clinicians about patient ... from patients + Ongoing chart review / audit of clinical staff to ensure quality care and...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of… more
- CenterWell (Savannah, GA)
- …around clinical protocols / disease + prevalence / appropriate levels of clinical quality care + Providing guidance to individual clinicians about patient ... from patients + Ongoing chart review / audit of clinical staff to ensure quality care and...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of… more
- ERP International (Barksdale AFB, LA)
- …care through a continuum facilitating the achievement of optimal outcomes in clinical , quality and cost-effectiveness arenas. Provides direct clinical ... most cases a referral to the Internal Behavioral Health Consultant (IBHC) in Primary Care is appropriate for an...to change. Possesses knowledge of disease management programs and clinical practice guidelines (eg VA/DoD CPGs), and HEDIS… more
- CenterWell (Phoenix, AZ)
- …relationship environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding ... and provide medical direction in pursuit of cost effective, quality healthcare. + Plan, organize, manage and supervise the...in the state of desired employment + Experience leading clinical practice operations + Demonstrate a high level of… more
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