• Lead Abstractor, HEDIS /Quality Improvement…

    Molina Healthcare (San Antonio, TX)
    …Lead Abstractor conducts data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection. The ... + Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers… more
    Molina Healthcare (08/08/25)
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  • Risk & Quality Performance Manager (Remote)

    Molina Healthcare (Austin, TX)
    **Job Description** **Job Summary** The Risk & Quality Performance Manager position will support Molina's Risk & Quality Solutions (RQS) team. This position ... to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success. * Partner with other teams to ensure data quality… more
    Molina Healthcare (07/31/25)
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  • Provider Engagement Account Manager

    Centene Corporation (Houston, TX)
    …improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS /quality, cost and utilization, etc. + Completes special projects as assigned ... at a medical group, IPA, or health plan setting. Proficient in HEDIS /Quality measures, cost and utilization.Pay Range: $55,100.00 - $99,000.00 per year Centene… more
    Centene Corporation (08/14/25)
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  • Manager , Utilization Management (RN)

    Evolent (Austin, TX)
    …driving results, and collaborating with others. **Collaboration Opportunities:** + The Manager , Client Services oversees daily utilization management and directs the ... global workforce and a working knowledge of clinical quality metrics such as HEDIS and NCQA - Preferred. + Skilled in inpatient and outpatient utilization… more
    Evolent (08/14/25)
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  • Senior Client Coding Project Manager

    Datavant (Austin, TX)
    …to realize our bold vision for healthcare. As a Sr. Client Coding Project Manager , you will plan, forecast, and manage client-facing coding projects. You will work ... + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. + Familiarity with HIPAA patient privacy requirements. + Excellent… more
    Datavant (06/28/25)
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  • Senior Account Manager - Healthcare

    Drips (TX)
    …journey, helping national, regional, and local health plans improve Stars, HEDIS , HOS, Medication Adherence, acquisition, and retention strategies. Our work in ... today's value-driven landscape. Job Overview: We are seeking a driven Senior Account Manager with healthcare experience to join our growing team during a critical… more
    Drips (06/21/25)
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  • Manager , Provider Relations

    Molina Healthcare (Houston, TX)
    …Plan. * Develops and implements strategies to increase provider engagement in HEDIS and quality initiatives. * Engages contracted network providers regarding cost ... control initiatives, Medical Care Ratio (MCR), non-emergent utilization, and CAHPS to positively influence future trends. * Develops and implements strategies to reduce member access grievances with contracted providers. * Oversees the IHH program and ensures… more
    Molina Healthcare (06/22/25)
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  • Quality RN Professional

    CenterWell (Port Arthur, TX)
    …across the following areas: + Quality/clinical management and population health + HEDIS and Stars performance + Operational improvements + Financial performance and ... state + 5+ years of clinical nursing experience + Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement + Strong knowledge of … more
    CenterWell (07/08/25)
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  • Clinical Quality Consultant NP 100% Virtual,…

    Elevance Health (Houston, TX)
    …capture initiatives and high-quality clinical documentation. + Chart reviews for closing HEDIS care opportunities to ensure practice and health plan success. + ... of ICD-10 CM, CMS guidelines including Risk Adjustment payment model, STARS and HEDIS highly preferred. + Clinical review experience. Please be advised that Elevance… more
    Elevance Health (08/15/25)
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  • PRN/Float Medical Assistant

    CenterWell (Corpus Christi, TX)
    …(EHR) and electronic medical record (EMR) systems, including documentation of HEDIS and Stars quality measures + Maintain established quality control standards ... years MA experience * Value Based Care experience including knowledge of HEDIS , CPT/ICD coding, and CAHPS/HOS Patient Experience. * Bilingual proficiency in English… more
    CenterWell (08/14/25)
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