• HEDIS Reviewer II

    US Tech Solutions (May, OK)
    …to assist in any way possible to complete the screenings. * Search for relevant HEDIS records from databases, review medical records using HEDIS technical ... Participates in the member and provider outreach, collection, and review of medical records to abstract clinical information for... of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to… more
    US Tech Solutions (05/07/25)
    - Save Job - Related Jobs - Block Source
  • RN Care Coordinator II

    Covenant Health Inc. (Knoxville, TN)
    …a proud member of Covenant Health! Position Summary: The RN Care Coordinator II is responsible for integrating evidenced based clinical practice into the patient ... resource and consultant to the health care team. The RN Care Coordinator II is responsible for promoting patient care coordination and quality through the… more
    Covenant Health Inc. (07/23/25)
    - Save Job - Related Jobs - Block Source
  • Registered Nurse - PACT Outpatient

    Veterans Affairs, Veterans Health Administration (Elizabeth City, NC)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... disease management program. Monitors PACT metrics with particular emphasis on HEDIS measures. Demonstrates proficiency in PACT reports including eQM (electronic… more
    Veterans Affairs, Veterans Health Administration (07/18/25)
    - Save Job - Related Jobs - Block Source
  • MA Quality Performance, Pop Health Boise Clinics…

    Trinity Health (Boise, ID)
    …Quality Performance Improvement initiatives (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at one of our ... PHMA work includes supporting system-wide quality performance goals for HEDIS and STAR measures. This role reports to the...payor lists for open gaps in care, completing chart review for documentation of gap closure, and potentially some… more
    Trinity Health (07/11/25)
    - Save Job - Related Jobs - Block Source
  • Case Manager, RN or Licensed Behavioral Health (SN…

    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. ... + Performs other functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) +...being met, such as NYS DOH, CMS, NCQA, and HEDIS , serving as internal auditor within the group. +… more
    Excellus BlueCross BlueShield (06/27/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director, Commercial Line of Business

    Excellus BlueCross BlueShield (Rochester, NY)
    …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical ... clinical reviews with attending physicians or other providers to discuss review determinations with providers and external physicians. + Conduct clinical appeal… more
    Excellus BlueCross BlueShield (07/01/25)
    - Save Job - Related Jobs - Block Source
  • Pharmacist (Associate Service Chief)

    Veterans Affairs, Veterans Health Administration (Palo Alto, CA)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... successful attainment of clinical performance measures affecting the SAIL and HEDIS measures. Ensures accountability among staff in meeting performance standards by… more
    Veterans Affairs, Veterans Health Administration (07/22/25)
    - Save Job - Related Jobs - Block Source
  • Lead Medical Support Assistant

    Veterans Affairs, Veterans Health Administration (Hampton, VA)
    …national scheduling guidelines. Coordinate with the patient care team to review clinic utilization by using various report clinic utilization statistical summary, ... delinquency report, secure messages, VeTEXT, VAR, as well as SAIL/ HEDIS metrics that directly impact the PACT team's metrics...written English in accordance with VA Handbook 5005, part II , chapter 3, section A, paragraph 3j. May qualify… more
    Veterans Affairs, Veterans Health Administration (07/15/25)
    - Save Job - Related Jobs - Block Source