- Molina Healthcare (St. Petersburg, FL)
- …member/ provider ( HEDIS ) outreach and/or quality intervention or improvement studies (development, implementation, evaluation) and Director level experience. ... subject matter expert and lead for Molina Plan quality improvement HEDIS operations using a defined roadmap,...at least 4 years in health plan quality or process improvement or equivalent/related experience. * Operational… more
- Somatus (Mclean, VA)
- …validating HEDIS , medical record reviews_ . Reporting directly to the HEDIS Director , this position will maintain effective communication with internal and ... expert for Policy and Standard Operating Procedures (SOPs) related to HEDIS technical specifications, abstraction, and process intervention. Responsibilities… more
- Centene Corporation (Nashville, TN)
- …analysis, claim and metric/dashboard tracking.** **Position Purpose:** Lead and direct process improvement activities that provide more efficient and streamlined ... on workplace flexibility. **Remote Opportunity** **Ideal candidate will have background in HEDIS Operations and Risk Adjustment with experience in clinical data… more
- Centene Corporation (Columbus, OH)
- …six months of the date of hire.** **Position Purpose:** Lead and direct process improvement activities that provide more efficient and streamlined workflow. + ... state of Ohio.** **Have experience in quality management and quality improvement .** **Have one of the following active: Ohio-licensed registered nurse, physician,… more
- Sharp HealthCare (San Diego, CA)
- …conjunction with the Director of PHM/ Medical Management and Quality Improvement Director . + Oversees and mentors Medical Directors and Physician Reviewers. ... programs and work plans. + Assists the Chief Medical Officer and the Quality Improvement Director in creating and maintaining a system that gives feedback to… more
- Highmark Health (Pittsburgh, PA)
- …Drives efficient operational functions to achieve established Quality measures, STARS and HEDIS performance ratings. Directs and manages team of ~75 employees that ... as necessary; may have budgetary responsibility and authority. + Quality Improvement Specialist (QIS) Program:Vision and direction for leading embedded coder/… more
- Martin's Point Health Care (Portland, ME)
- …leadership in, or focused activity of, a Health Plan (preferred) + Knowledge of process improvement tools + Experience in Health Plan utilization management + ... Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the...MLR , inpatient days/1000, SNF days/1000, and clinical quality improvement (QI) objectives, including HEDIS and how… more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in the operational areas of care management, utilization ... review, appeals, quality improvement and related policy and practice initiatives in collaboration...and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs.… more
- Sharp HealthCare (San Diego, CA)
- …and Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager. + Participates in the grievance process with the Chief ... in short and long range program planning, total quality management (quality improvement ), and external relationships. Works with all departments of Health Services… more
- Molina Healthcare (Ann Arbor, MI)
- … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- Molina Healthcare (Layton, UT)
- … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... medical policies, guidelines and medical criteria. + Assists with training medical director colleagues and nursing staff , including leadership of teaching grand… more
- CenterWell (Orlando, FL)
- …caring community and help us put health first** The Associate Operations Director (AOD) leads Senior Focused Primary Care clinical operations in a multi-physician ... achieve optimal patient outcomes and company initiatives, including Quality, HEDIS /STARs, AHCA, optimal patient scheduling, financial management, patient engagement,… more
- Mom's Meals (Ankeny, IA)
- Position SummaryThe Director of Healthcare Partnerships will build and foster relationships with strategic accounts that may have a regional/national presence and/or ... (Long-term Services and Supports), Post-discharge and/or Chronic Care meals programs. Director of Healthcare Partnership leads a team of regional field-based… more
- Evolent (Atlanta, GA)
- …of our specialty programs and administrative platform. **Role Overview** The Senior Director role on Client Analytics will lead the development and execution of ... ensuring compliance with applicable guidelines. + Lead the design, development, improvement , and maintenance of BI dashboards and reports that provide actionable… more
- Molina Healthcare (Lexington, KY)
- …nature of the performance measurement data collection, reporting and monitoring process , including HEDIS , state-based measure reporting and medical record ... the soundness and correctness of data used to create HEDIS results. Manages state's annual CAHPS survey process...Defines use of in-house vs. vendor strategy for each HEDIS season. + May implement improvement activities… more
- Veterans Affairs, Veterans Health Administration (Augusta, GA)
- …of compliance with expected clinic operational and quality metrics (SAIL, HEDIS , etc. An integral member of the Interdisciplinary Polytrauma/TBI Team, ... necessary. Participates in selected committees. Participates in Service Quality Improvement /Performance Improvement , and Quality Management activities. Others… more
- Sanford Health (Sioux Falls, SD)
- …ability to clarify performance targets and objectives to drive project and process improvement strategies. Knowledge of human resources and personnel management ... satisfaction, and administrative outcome indicators for quality and continuous improvement . Responsible for providing professional, technical, and clinical expertise.… more
- Adelante (Phoenix, AZ)
- …position will work closely with WIC training Coordinator and WIC operations to implement process improvement and monitor process improvement changes. ... Director of WIC to identify opportunities for quality improvement and oversee performance improvement initiatives. This...degree + Experience in managed care with knowledge of HEDIS and STARS Quality Metrics preferred + Quality Assurance… more
- Trinity Health (Boise, ID)
- …hire. + Electronic health record (EHR) experience required. + Experience with process improvement or Lean philosophy preferred. **Highlights and Benefits** When ... and the highest quality of care. The Quality Performance Improvement , Population Health Team is now hiring for a...initiatives (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at… more
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