- Centene Corporation (Springfield, IL)
- …that meets directly with provider groups based in the Chicago area to discuss HEDIS performance and strategize ways to improve performance, up to 75% travel. Typical ... sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for ...following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN , APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance **Position Summary:** The HEDIS Network Analyst will support CCA's ability to meet and surpass critical Quality ... **Essential Duties & Responsibilities:** + **Conduct weekly tracking of Quality/ HEDIS metrics, specifically focused on Initiation and Engagement of Alcohol or… more
- Centene Corporation (Phoenix, AZ)
- …in quality function in a healthcare setting. **License/Certification:** LPN, LVN, RN , PA, or LCSW license preferred. CPHQ (Certified Professional in Healthcare ... time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's… more
- Centene Corporation (Columbia, SC)
- …Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse ( RN ) preferred. Pay Range: $26.50 - $47.59 ... IPA and/or group practices. Serves to collaborate with providers in the field , to improve HEDIS measures and provides education for HEDIS measures and… more
- Centene Corporation (Surfside Beach, SC)
- …provider groups based in South Carolina to discuss and improve HEDIS performance. Typical daily tasks will include creating/using PowerPoint presentations, ... South Carolina, (2) have a pediatric background, and (3) an active RN license.** Additional Details: * Department: MED-Quality Improvement * Business Unit: Absolute… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Registered Nurse Care Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift About Us Covenant Medical Group employs or manages ... coordination services within the scope of practice as a registered nurse meeting all required standards both...or CPHQ OR Bachelors degree in Nursing or related field . Apply/Share Job Title RN CARE COORDINATOR… more
- Health Care Service Corporation (Mobile, AL)
- …healthcare outcomes for customers. **Required Job Qualifications:** + Current Licensure as a registered nurse , in the state of residence in good standing. + ... utilization management position (experience can be a combination of LVN/ RN licensure) + Previous HEDIS and/or CMS...using Microsoft Excel + **Client-site Location:** This is a field based position in Mobile, AL and surrounding towns.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... All Levels + Associates degree required. Bachelor's degree preferred. + Active NYS RN or Registered Dietician or Physical Therapist licensure required. + Minimum… more
- University of Southern California (Alhambra, CA)
- …InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic ... the status and processing of requests received from ambulatory care management nurse . 8. Assesses ongoing discharge planning needs and documents is computer system… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …values Every. Single. Day. Aspirus Health Plan in Wausau, WI is seeking a RN QUALITY IMPROVEMENT SPECIALIST to join our ASPIRUS HEALTH PLAN team ! This position ... implement a cohesive Quality Improvement Program that supports NCQA, HEDIS and Medicare Star Ratings. HOURS: Full Time or...3-5 years of experience in a health care related field preferred. + NCQA accreditation experience is preferred. +… more
- Centene Corporation (Lansing, MI)
- …Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse ( RN ), Acute Care Nurse Practitioner ... sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Provides education for HEDIS measures, appropriate medical record… more
- Centene Corporation (Indianapolis, IN)
- …provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, ... plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for...following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN , APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS… more
- Centene Corporation (Austin, TX)
- …provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, ... plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for...following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN , APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS… more
- Centene Corporation (Austin, TX)
- …health insurance experience required; 2+ years of quality experience preferred. **License/Certification:** Registered Nurse ( RN ), Licensed Practical Nurse ... market trends and oversee functions of quality improvement programs for HEDIS , CAHPS, and/or HOS strategy and related quality improvement activities. Assists… more
- Centene Corporation (Lansing, MI)
- …Lead data collection and abstraction for company quality measures, including HEDIS , CMS, CHIPRA and/or any other custom measurements. + Assess vendor-delegated ... abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS … more
- Blue KC (Kansas City, MO)
- …+ Experience working for a health plan and/or within a provider office + Registered Nurse and/or medical licensure + Knowledge base of clinical standards of ... + Analyze data and monitor provider metrics to identify risk adjustment, HEDIS or educational opportunities for the Medicare Advantage and Qualified Health Plan… more
- Fallon Health (New Bedford, MA)
- … field preferred. **License** : Active, unrestricted license as a Registered Nurse in Massachusetts **Certification** : Certification in Case Management ... Program policies and processes Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member...**Experience:** * 1+ years of clinical experience as a Registered Nurse managing chronically ill members or… more
- Centene Corporation (Maumee, OH)
- …insurance experience required; 1+ year quality experience preferred. **License/Certification:** Registered Nurse , Licensed Practical Nurse , Licensed ... states, and have a (2) combination of experience in the following areas: HEDIS , managed care, quality, process improvement/ project management (such as lean, CPHQ,… more
- CDPHP (Latham, NY)
- …varied clinical expertise (ex. Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, ... and scope of practice requirements for each specific health-related field /specialty + Maintains confidentiality and conducts information management procedures per… more
- Humana (Little Rock, AR)
- …impact** **Required Qualifications** + Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a related field , or equivalent work experience + ... Time Zone) **Preferred Qualifications** + Master's Degree in Business, Finance, Health Care/Administration, RN or a related field + Experience with Medicare Risk… more