• Supervisor, HEDIS

    Centene Corporation (Columbus, OH)
    …functional process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities + Manager the ... workplace flexibility. **Position Purpose:** Supervise and coordinate team ensure HEDIS data accuracy and reporting, including investigations, auditing, and… more
    Centene Corporation (04/20/25)
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  • Lead Overreader, HEDIS /Quality Improvement…

    Molina Healthcare (Columbus, OH)
    …regarding quality and HEDIS review and results. + Works with the Manager to monitor accuracy of abstracted records as required by specifications. + Assists the ... the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental...off of the audit and chart review. + Assists Manager and Supervisor(s) in leading the training and mentoring… more
    Molina Healthcare (04/22/25)
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  • Lead Overreader, HEDIS Abstraction…

    Molina Healthcare (Columbus, OH)
    …regarding quality and HEDIS review and results. + Works with the Manager to monitor accuracy of abstracted records as required by specifications. + Assists the ... the data collected and abstracted from medical records for HEDIS projects, HEDIS like projects and supplemental...off of the audit and chart review. + Assists Manager and Supervisor(s) in leading the training and mentoring… more
    Molina Healthcare (04/11/25)
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  • HEDIS Abstractor II (Temporary)

    LA Care Health Plan (Los Angeles, CA)
    HEDIS Abstractor II (Temporary) Job Category: Clinical Department: Quality Performance Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... that purpose. Job Summary The Healthcare Effectiveness Data and Information Set ( HEDIS ) Abstractor II reviews medical records to ensure completeness, compliance with… more
    LA Care Health Plan (04/09/25)
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  • Manager , Performance Quality Improvement

    Centene Corporation (Jefferson City, MO)
    …Assurance (NCQA) and Healthcare Effectiveness Data and Information Sets ( HEDIS ) performance improvement projects. + Oversee quality improvement related activities ... (ie outcome studies, QI projects) + Coordinate ongoing data management for HEDIS and QI project management databases. Evaluate sources for alternative data capture,… more
    Centene Corporation (04/27/25)
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  • Manager , Clinical Quality Improvement

    VNS Health (Manhattan, NY)
    …+ Leads the clinical audit team, ensuring compliance with Medicare STARS, HEDIS /QARR, and regulatory requirements. + Develops forms, record abstracts, reports, and ... accuracy, documentation, and quality reporting to improve STARS and HEDIS scores. + Acts as the primary clinical liaison...for IPAs and provider networks, ensuring alignment with STARS, HEDIS , and clinical quality objectives. + Works closely with… more
    VNS Health (03/13/25)
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  • Accreditation Project Manager

    Centene Corporation (Raleigh, NC)
    …and education programs for Plan, provider network, delegated vendors to support NCQA and HEDIS activities. + Develop QI, NCQA and HEDIS projects with delegated ... vendors to support accreditation maintenance and HEDIS reporting. + Coordinate assigned NCQA and ... HEDIS reporting. + Coordinate assigned NCQA and HEDIS work plan activities. + Assist with delegation oversight… more
    Centene Corporation (04/11/25)
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  • Clinical Quality Manager

    Healthfirst (NY)
    …chronic disease management + Assists in writing member and/or provider articles on HEDIS , QARR, Medicare Advantage, and/or health promotions for the HF newsletter + ... LPN, RN, LMSW or LCSW + Multiple years of HEDIS review experience for both Medicaid and Medicare lines...business + Medical record review experience directly working on HEDIS /QARR in a managed care setting + Good presentation,… more
    Healthfirst (02/08/25)
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  • Manager , Quality Improvement, Clinical

    CenterWell (Dallas, TX)
    …and help us put health first** **Job Profile Summary** The Manager , Stars Improvement, Clinical responsible for the development, implementation and management ... oversight of the Primary Care Organization's clinic-based Stars Program. The Manager , Stars Improvement, Clinical works within specific guidelines and procedures;… more
    CenterWell (04/08/25)
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  • Manager , Health Plan Quality Interventions…

    Molina Healthcare (Columbus, OH)
    …surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Manager , Health Plan Quality Interventions is responsible for developing, ... implementing, and monitoring the success of quality improvement interventions. The Manager works to coordinate resources and training within the health plan and… more
    Molina Healthcare (04/25/25)
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  • Clinic Manager

    CenterWell (Arlington, TX)
    …CenterWell is a subsidiary of Humana, seeking a Primary Care Clinic Manager , that develops and leads implementation for staffing plans, policies and procedures ... patient outcomes and company initiatives including but not limited to Quality, HEDIS / STARs, AHCA, financial management and employee and patient retention. Must… more
    CenterWell (04/23/25)
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  • Quality Practice Manager (QPM) Las Cruces…

    LifePoint Health (Las Cruces, NM)
    …visits, colonoscopies, cervical cancer screenings, and mammograms. The Quality Practice Manager (QPM) will collaborate with employed practices to achieve local ... The QPM establishes and maintains practice/provider relationships, presenting, practices HEDIS , STARS, and RAF training and planning, and contract performance… more
    LifePoint Health (04/16/25)
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  • Risk & Quality Performance Manager (Remote)

    Molina Healthcare (Columbus, OH)
    **Job Description** **Job Summary** The Risk & Quality Performance Manager position will support Molina's Risk & Quality Solutions (RQS) team. This position ... to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success. * Partner with other teams to ensure data quality… more
    Molina Healthcare (04/25/25)
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  • Sr. Risk & Quality Performance Manager

    Molina Healthcare (Columbus, OH)
    **Job Description** **Job Summary** The Sr Risk & Quality Performance Manager is a tactical execution role that will lead specific projects to support Molina's Risk ... experience in risk adjustment and/or quality * 4+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems * 4+ years of… more
    Molina Healthcare (03/04/25)
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  • Manager Risk Adjustment Operations

    Premera Blue Cross (Mountlake Terrace, WA)
    …in Risk Adjustment Operations? We invite you to join our team as the ** Manager of Risk Adjustment Operations** , where you will lead our core operations team. ... retrieval for risk adjustment and some retrieval support for quality/ HEDIS . As a key member of our team, you...related field + Experience with quality measures, inclusive of HEDIS , CAHPS, and HOS + Experience with provider community… more
    Premera Blue Cross (04/11/25)
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  • Provider Engagement Account Manager

    Centene Corporation (Getzville, NY)
    …improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS /quality, cost and utilization, etc. + Completes special projects as assigned ... at a medical group, IPA, or health plan setting. Proficient in HEDIS /Quality measures, cost and utilization.Pay Range: $55,100.00 - $99,000.00 per year Centene… more
    Centene Corporation (04/30/25)
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  • LPN/MA Care Manager , Advanced Primary Care

    Praxis Health (Portland, OR)
    …+ Coordinate with centralized PXH/Regence teams to drive performance in: + HEDIS metric tracking + Transitional Care Management (TCM) + Annual Wellness Visit ... care. Required Experience + Population health program involvement or leadership + HEDIS metrics tracking and improvement + Outpatient primary care setting experience… more
    Praxis Health (04/23/25)
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  • Manager Population Health - Sharp Health…

    Sharp HealthCare (San Diego, CA)
    …California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification **Hours** **:** ... the position, and employer business practices. **What You Will Do** The manager plans, directs, and coordinates the development and implementation of the ambulatory… more
    Sharp HealthCare (04/30/25)
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  • Manager - Quality Programs

    Independent Health (Buffalo, NY)
    …a culture that fosters growth, innovation and collaboration. **Overview** The Manager , Quality Programs will lead the execution of identified/approved operations, ... plans/roadmaps in support of both department and organizational goals/objectives. The Manager will provide direction in the priority, assignment, and distribution of… more
    Independent Health (03/13/25)
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  • Nurse Manager (RN or LPN)

    Sea Mar Community Health Centers (Puyallup, WA)
    …position(s): Sea Mar is a mandatory COVID-19 and flu vaccine organization Nurse Manager - Posting #26096 Nurse Manager RN Annual Salary: $85,470.00 Nurse ... LPN Annual Salary: $74,958.09 Position Summary: Full-time Nurse Manager position available for our Medical Clinic in Puyallup,...or hospitals + Focus clinic efforts on quality measures, HEDIS , and Meaningful Use standards + Provide annual MA… more
    Sea Mar Community Health Centers (02/12/25)
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