- Humana (Baton Rouge, LA)
- …a part of our caring community and help us put health first** The Director , Quality Improvement implements quality improvement programs for all lines ... business including annual program description, work plan, and annual evaluation. The Director , Quality Improvement requires an in-depth understanding of how… more
- Elevance Health (Woodbridge, NJ)
- …management skills. + Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet ... **Medicaid Quality Management Health Plan Director ** **Preferred Location: Iselin, NJ.** This role requires...quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement , NCQA accreditation… 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
- 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
- Molina Healthcare (Dayton, OH)
- … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to the… more
- Martin's Point Health Care (Portland, ME)
- …and service delivery channels. + Develops, implements, and ensures continuous quality improvement and process improvement to deliver effective and ... + Knowledge of NCQA accreditation + Experience leading accreditation and clinical process improvement efforts + Experience managing operational or project… more
- AmeriHealth Caritas (Newtown Square, PA)
- …more about us at www.amerihealthcaritas.com. **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 with the Corporate Medical … more
- CenterWell (Olathe, KS)
- …caring community and help us put health first** The Associate Operations Director , Clinic/Center Administration, plans and directs the work of professional and ... outpatient care to patients in a clinical setting. The Associate Director , Clinic/Center Administration requires a solid understanding of how organization… more
- Molina Healthcare (Dayton, OH)
- … 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
- ZoomCare (Portland, OR)
- …part of our dedicated, fast-moving team of superstars! ZoomCare is seeking a **Medical Director of Primary Care** to join our team! The Medical Director of ... and implement strategies to improve performance on key quality metrics (eg, HEDIS , STAR Ratings, preventive screenings, and chronic care management). + Monitor and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Monitor the initiatives to measure results. + Monitor pharmacy trends; recommend process , product, and program improvement ; plan, implement, and monitor changes. ... and willingness to work in a hybrid environment **Responsibilities:** The Pharmacy Director manages team members who support the following activities: + Monitor the… more
- Beth Israel Lahey Health (Wakefield, MA)
- …revenue in our quality risk arrangements. This role facilitates strategic process improvement initiatives through planning, development, and operationalization ... + May produce complex documents, perform analysis and maintain databases Knowledge of process improvement initiatives such as LEAN or Six Sigma a plus… 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)
- …preferred. + Electronic health record (EHR) experience required. + Experience with process improvement or Lean philosophy preferred. **Highlights and Benefits** ... 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
- Independent Health (Buffalo, NY)
- …to achieve maximum performance and return on investment. In conjunction with the Director , the Manager will work closely with all areas of Health Care ... the department on cross-functional teams and as requested by the Director . **Qualifications** + Bachelor's degree or Registered Nursing License (RN) required.… more
- Elevance Health (St. Rose, LA)
- …risk management and/or utilization review in a managed care setting as well as process improvement ; or any combination of education and experience which would ... you make an impact:** + Provides recommendations for quality improvement studies including selection of valid and reliable indicators...annual and ad hoc medical record reviews such as HEDIS and CPG compliance. + Conducts quality of care… more
- MyFlorida (Bonifay, FL)
- …operations. This position reports directly to the Executive Community Health Nursing Director . The position must be able to work independently requiring little ... out of office. Reviews non-compliant Healthcare Effectiveness Data and Information Set ( HEDIS ) list, supplied by Billing Clerks at Holmes and Washington. Sends… more
- Elevance Health (Seven Fields, PA)
- …risk management and/or utilization review in a managed care setting as well as process improvement ; or any combination of education and experience which would ... Investigate member and administrative complaints. + Investigate care concerns, an internal quality process that works with providers on assessing if there is a need… more
- Community Health Systems (Naples, FL)
- …who needs a reasonable accommodation for any part of the application or hiring process , contact the director of Human Resources at the facility to which ... **Job Summary** Under the direction of the UR Director /Manager the UR Nurse reviews all admissions for...members, providers, and leadership. Support and focus on performance improvement of the UR KPI's. Ensures proper and accurate… more
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