- BlueCross BlueShield of North Carolina (NC)
- …descriptions, HPMS memos, QIC coordination and facilitation, policy coordination. + Support annual HEDIS functions such as: rate review , HEDIS roadmap, ... ensure vendors meet service level agreements if applicable. + Review reports and records of activities to ensure progress...of experience in related field + Knowledge of DSNP clinical quality improvement operations and HEDIS **Bonus… more
- Dignity Health (Bakersfield, CA)
- …a system/national level in the population health space. **Position Summary:** The Manager , Clinical Quality Improvement, is responsible for leading multiple ... for projects that are consistent with the organization's strategic goals. The Manager , Clinical Quality Improvement will oversee the day-to-day management of… 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 ... and social determinants of health. The role encompasses analysis and review of trends and projections of key clinical metrics, supporting new program… more
- Elevance Health (Seven Fields, PA)
- …quarterly, annual and ad hoc medical record reviews such as ASAM monitoring, HEDIS and Clinical Practice Guideline (CPG) compliance. + Coordinates site visit ... **JR152864 Behavioral Health Clinical Quality Audit Analyst Sr** This role is...outreach interventions, provider education and outreach interventions, medical record review , focus studies and surveys. + Conducts quality of… more
- Molina Healthcare (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
- Praxis Health (Eugene, OR)
- …healthcare clinic, and we're searching for an experienced LPN or MA Care Manager to join our advanced primary care team. This is a high-impact, in-house ... role for a licensed or certified clinical professional with a strong background in care coordination...with centralized PXH/Regence teams to drive performance in: + HEDIS metric tracking + Transitional Care Management (TCM) +… more
- Fallon Health (Worcester, MA)
- …the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, ... us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The Nurse Case Manager (NCM) is an integral part on an interdisciplinary team focused on care… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society… more
- Community Health Systems (Naples, FL)
- …of Nursing, ASN required or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required + Experience in HEDIS , MIPS, PQRS, ACO, STARS ... **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for...programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. +… more
- Robert Half Finance & Accounting (Shrewsbury, MA)
- Description The Revenue Cycle Manager is responsible for overseeing and optimizing the end-to-end revenue cycle processes, a Federally Qualified Health Center (FQHC) ... standards, KPIs, and SLAs related to vendor performance. * Review and escalate vendor issues that impact cash flow...* Analyze claims data and suggest/implement procedures to maximize UDS/ HEDIS and incentive revenue collections (ie, ICD-10 and CPT… 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, NCQA ... in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set ( HEDIS ) improvement action plans, year-round medical record review , and… more
- CenterWell (Jacksonville, FL)
- …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals +… more
- Highmark Health (Harrisburg, PA)
- …+ Proactively engages the practice care team and provides "hands on" management of clinical quality measures and quality chart review . (5%) + Participate in the ... 2 days work from home. Location and schedule discussed with hiring manager . **GENERAL OVERVIEW:** Responsible for working collaboratively with primary care providers… more
- Sharp HealthCare (San Diego, CA)
- …process. + Participates in risk management, pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review ... all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends in grievances. Supervises the process for identifying Potential… more
- Trinity Health (Fruitland, ID)
- …provides education, training, support, and collaboration with primary care clinical teams and providers to support Quality Performance Improvement initiatives ... (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will support the Fruitland Health...and STAR measures. This role reports to the SAMG Manager of Quality Performance Improvement, Population Health. + This… more
- Trinity Health (Boise, ID)
- …provides education, training, support, and collaboration with primary care clinical teams and providers to support Quality Performance Improvement initiatives ... (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at...and STAR measures. This role reports to the SAMG Manager of Quality Performance Improvement, Population Health. + This… more
- Sharp HealthCare (San Diego, CA)
- …and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its' Chief Medical Officer. ... in risk management reviews. + Assists in pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review … more
- Fallon Health (Worcester, MA)
- …limited to, NCQA, HEDIS , CMS, State, Medicare Five Star, External Quality Review projects, etc. * Participating in the preparation of member cases files for ... the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge,… more
- Adelante (Peoria, AZ)
- …results in the electronic health record. Clinical Collaboration + Collaborate with the clinical team to review and act on Tasks/PTAs sent by providers. + ... conducting thorough assessments of their health needs, performing essential clinical procedures, and facilitating comprehensive care plans. Collaboration with… more
- CenterWell (Richmond, VA)
- …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals +… more
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