- MetroPlusHealth (New York, NY)
- …and other large volume providers to address cost. as well as HEDIS /QARR quality performance, preferred. Licensure and/or Certification Required: LCSW, LMSW, ... Management (BH UM) Clinician is responsible for conducting utilization and quality management activities in accordance with New York State and MetroPlusHealth… more
- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a Medical Director , Behavioral Health Children's Services , to join #TeamMVP. If you have a ... years must be in a clinical setting). Previous experience as a medical director in a managed care/health plan is desirable. Individuals must understand various… more
- Commonwealth Care Alliance (Boston, MA)
- …program consultants with future expansion. **Essential Duties & Responsibilities:** **Provider Quality Performance and Value-Based Care** + Lead implementation ... population health, or related area + Demonstrated experience interpreting and applying quality measures ( HEDIS , CAHPS, HOS) and value-based contract performance… more
- CVS Health (Harrisburg, PA)
- …will do** + Lead team of experienced analysts in support of HEDIS and other quality measure performance forecasting (ARIMA, exponential smoothing, regression ... And we do it all with heart, each and every day. Leads quality measure focused forecasting analytics and tableau dashboard team. Administers quality … more
- Molina Healthcare (OH)
- …within the department and/or collaboratively with other departments. Please include any HEDIS / Quality experience on your resume. This experience is important for ... & Community Interventions oversees and implements new and existing clinical quality member intervention initiatives including all lines of business (Medicare,… more
- HCA Healthcare (Campbell, CA)
- …alone, HCA Healthcare colleagues invested over 156,000 hours impacting our communities. As a Director of Quality and Risk Adjustment with HCA Healthcare, you can ... vary by location._** Come join our team as a Director of Quality and Risk Adjustment. We...Incorporate changes and requirements into strategy and forecasts + Lead the collaboration between Risk Adjustment, Quality ,… more
- Sharp HealthCare (San Diego, CA)
- …+ Responsible and accountable for implementing the Utilization/Cost Management Program and Quality Improvement Program, in conjunction with the Director of PHM/ ... health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical...Medical Management and Quality Improvement Director . + Oversees and mentors Medical Directors and Physician… more
- ChenMed (Warren, MI)
- …position towards becoming a center clinical P&L leader (ie, Senior Medical Director [SMD]) in the organization. The incumbent Center Medical Director ... may be simultaneously completing PCP Black Belt Training and Mastering the Medical Director Essentials within a combined and accelerated PCP and medical director … more
- CVS Health (Frankfort, KY)
- …plan and external partners for the state Managed Medicaid pharmacy benefit. The Pharmacy Director reports to the Senior Lead Pharmacy Director and holds ... as drug pricing transparency, medication safety, and controlled substance regulations. The Pharmacy Director is expected to attend and lead discussions as the… more
- ChenMed (Houston, TX)
- …position towards becoming a center clinical P&L leader (ie, Senior Medical Director [SMD]) in the organization. The incumbent Center Medical Director ... may be simultaneously completing PCP Black Belt Training and Mastering the Medical Director Essentials within a combined and accelerated PCP and medical director … more
- CenterWell (Las Vegas, NV)
- …environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators. **Scheduled Weekly Hours** 40 **Pay Range** The ... we want to help people everywhere, including our associates, lead their best lives. At We are seeking innovative...the healthcare industry as a whole. The Associate Medical Director serves as a health-care professional and capable of… more
- ChenMed (Margate, FL)
- …Manages clinical teams to deliver VIP service, standards of care and quality guidelines, HEDIS /STARS, high-risk disease detection and high-risk disease ... rapidly expanding and we need great people to join our team. The Medical Director , Center is specifically responsible for executing the ChenMed Way and core model in… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …management, decision-making, and problem-solving skills. + Knowledge of credentialing, quality , NCQA/ HEDIS /CMS and/or Medicaid Star Ratings, and/or value-based ... 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… more
- Dignity Health (Bakersfield, CA)
- …medical director for the Population Health Services Organization (PHSO) quality division. - Analyze Physician/APP KPIs to identify improvement opportunities for ... primarily in the Bakersfield/Central CA region.** **Position Summary:** The Medical Director of Physician Engagement is responsible for developing and driving… more
- Molina Healthcare (Albuquerque, NM)
- …clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director , and quality improvement staff. + ... action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the...including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge.… more
- Molina Healthcare (Lincoln, NE)
- …clinical quality improvement activity (QIA) in collaboration with the clinical lead , the medical director , and quality improvement staff. + ... action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the...including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge.… more
- Drips (OH)
- Position Title: VP or Director of Strategic Accounts Location: Remote Reports To: SVP of Healthcare Solutions Type: Full Time | High Impact | Quota-Carrying About ... journey, helping national, regional, and local health plans improve Stars, HEDIS , HOS, Medication Adherence, acquisition, and retention strategies. Our work in… more
- MVP Health Care (Rochester, NY)
- …thinking and continuous improvement. To achieve this, we're looking for a **Medical Director , Behavioral Health Children's Services** , to join #TeamMVP. If you have ... in a clinical setting). Previous experience as a medical director in a managed care/health plan is desirable. +...+ Knowledge of and experience with NCQA requirements and HEDIS reporting is desirable. + Strong organizational, communication, and… more
- AmeriHealth Caritas (Raleigh, NC)
- …regularly report on network performance to executive leadership. + Actively partners with Market Director of Quality to drive Company-wide and Plan quality ... **Job Summary** The Provider Network Performance & Engagement Director , is responsible for leading strategies and initiatives to optimize provider network… more
- CVS Health (Tallahassee, FL)
- …Quality of Service (grievance) issues. * Actively participate in or lead quality and/or member/provider service-focused committees. * Provide clinical ... (Dual-Eligible Special Needs Plan / Medicare-Medicaid Plan) * Develop and lead clinical strategy and objectives for the DSNP/FIDE populations, including the… more
