- Molina Healthcare (Cleveland, OH)
- …EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of ... Plan Risk and Quality leaders to improve outcomes by managing Risk/ Quality data collection strategy , analytics, and reporting, including but not limited… more
- Medical Mutual of Ohio (OH)
- …evaluations of more junior analysts. + Helps devise and implement clinical quality analytic strategy , priorities, and continuous improvement. Oversees work unit ... encounter, and quality measurement data. + Advanced knowledge of NCQA and CMS measurement requirements and quality rating systems. + Advanced proficiency in… more
- Humana (Columbus, OH)
- …Healthcare Administration, related field, or any field + 7 years of experience in project management or program management in healthcare or a related field + ... Enterprise Stars Activation model to ensure Medicare Advantage Stars strategy is consistently embedded across all lines of business....other advanced degree + Experience with Medicare Advantage and CMS Stars programs with HEDIS, CAHPS, HOS,… more
- Elevance Health (Mason, OH)
- …and Experiences** : + Degree in Accounting or Finance preferred. + Knowledge of CMS program regulations and cost report format preferred. + Knowledge of ... for Medicare and Medicaid Services to transform federal health programs . The **Audit and Reimbursement III** will support our...federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health and Human… more
- Elevance Health (Independence, OH)
- …five years._** **Preferred Qualifications** : + Accounting degree preferred. + Knowledge of CMS program regulations and cost report format preferred. + Knowledge ... the Centers for Medicare and Medicaid Services to transform federal health programs . The **Audit and Reimbursement Senior** will support our Medicare Administrative… more
- Molina Healthcare (Cincinnati, OH)
- …other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. This ... with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. +… more
- Cleveland Clinic (Mayfield Heights, OH)
- …a consultant in educating and evaluating clinical and support department staff regarding quality management regulations and standards of care. + Support medical ... Act as the primary resource for staff to facilitate overall operations of programs . + Develop meaningful quality assurance activities with clinical leadership to… more
- RELX INC (Dayton, OH)
- …monitoring product experience dashboard, forecasting analysis to action timely mitigations + Content management system and scheduling tools, including ... members; ensure collaborative partnerships with Editorial, Builds, Print Segment, and Content Strategy teams + Cross-Functional Collaboration: Work closely… more
- Molina Healthcare (Columbus, OH)
- …ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job ... and written communication skills. * Microsoft Office suite/applicable software program (s) proficiency. Preferred Qualifications * Utilization management , care… more
- Highmark Health (Columbus, OH)
- …clinical setting. + Experiencein Lean, Six Sigma, TQI, TQC or other quality management certification. + Experiencein health plan provider network performance ... that engage providers enrolled in the Organization's value-based reimbursement programs and continuous improvement models. The incumbent plays different potential… more
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