• Risk & Quality Performance Manager (Remote)

    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
    Molina Healthcare (09/19/25)
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  • HEDIS Analyst

    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
    Medical Mutual of Ohio (08/16/25)
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  • STARS Strategy Advancement Lead

    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
    Humana (09/26/25)
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  • Audit & Reimbursement III (US)

    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 (09/27/25)
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  • Audit & Reimbursement Senior

    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
    Elevance Health (09/25/25)
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  • LVN Delegation Oversight Nurse Remote

    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
    Molina Healthcare (09/20/25)
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  • Safety Quality Patient Experience…

    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
    Cleveland Clinic (09/10/25)
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  • Editorial Operations Lead, Global Analytical

    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
    RELX INC (08/29/25)
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  • Healthcare Services Operations Support Auditor

    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
    Molina Healthcare (09/28/25)
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  • Value-Based Reimbursement Specialist

    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
    Highmark Health (08/20/25)
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