- Molina Healthcare (Santa Fe, NM)
- …NCQA accreditation 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… more
- Baylor Scott & White Health (Santa Fe, NM)
- **JOB SUMMARY** As a licensed clinician, the Clinical Program Manager is accountable for leading clinical programs, clinical performance, and/or contract ... obligations. + Proactively identifies, plans, implements, evaluates, and monitors quality improvement and performance improvement initiatives. + Significantly contributes… more
- CenterWell (Santa Fe, NM)
- …for successful clinic performance + Maintain accurate and thorough documentation of clinical interventions and patient care activities + Conduct in-service ... and help us put health first** We are seeking an ambitious and goal-oriented Clinical Pharmacist with over 5 years of experience to join our primary care… more
- Sharecare (Santa Fe, NM)
- …support in an appropriate, efficient and cost-effective manner while ensuring high quality care. The Clinical Registered Nurse coordinates with the Primary ... total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible… more
- Public Consulting Group (Santa Fe, NM)
- …* Document all care activity via case management software system * Promotes quality and cost-effective interventions and outcomes * Assesses and addresses ... a qualified Registered Nurse to perform as a Case Manager . The Case Manager will be responsible...accurately all necessary forms and produce statistical reports Promotes quality and cost-effective interventions and outcomes +… more
- Highmark Health (Santa Fe, NM)
- …to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an ... performing ongoing assessment of members' health management needs, identifying the right clinical interventions to address member needs and/or triaging members… more
- Sharecare (Santa Fe, NM)
- …2025** **Salary:** **$85,000 annually, plus comprehensive benefits package** The Care Manager supports the implementation of the Value Based Care Management program ... in an appropriate and efficient manner by providing high- quality telephonic Case or Care Management with CareFirst members. The Care Manager partners with… more
- Molina Healthcare (Santa Fe, NM)
- …plan to achieve performance goals. + Direct management of QS HPP program manager . Coordination with health plan quality staff. Ensure organization with other ... years of experience in Managed Care and/or health plan quality . Clinical experience is needed for positions...for positions that are focused on Accreditation, Compliance, HEDIS Interventions , Potential Quality of Care issues, and… more
- Molina Healthcare (Santa Fe, NM)
- …HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of ... timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified… more
- Molina Healthcare (Santa Fe, NM)
- …accuracy of abstracted records as required by specifications. + Assists the quality improvement staff with physician and member interventions and incentive ... **Job Description** **Job Summary** Molina's Quality Improvement Lead Overreader conducts oversight and audits...off of the audit and chart review. + Assists Manager and Supervisor(s) in leading the training and mentoring… more
- Highmark Health (Santa Fe, NM)
- …performing ongoing assessment of members' health management needs, identifying the right clinical interventions to address member needs and/or triaging members ... panel of members that range in health status/severity and clinical needs; and assesses health management needs of the...personal health goals. Will work with providers to insure quality and appropriate care is being delivered in a… more
- Intermountain Health (Santa Fe, NM)
- …services, addresses barriers, and promotes optimal allocation of resources while balancing clinical quality and cost management. **Job Specifics** + Pay Range ... **Job Description:** The Social Work Care Manager works collaboratively with physicians and other members...patient/member per CMS Condition of Participation (COP) or National Clinical Quality Association (NCQA) standards. Ensures a… more