• Utilization Review - Registered

    Community Health Systems (Naples, FL)
    …meet deadlines. + Effective written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all...2-4 years clinical practice experience required + Experience in HEDIS , MIPS, PQRS, ACO, STARS preferred **Knowledge,… more
    Community Health Systems (07/12/25)
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  • Quality Improvement RN

    CenterWell (Tampa, FL)
    …excellence **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) without restriction in applicable state + ... us put health first** The Stars Improvement, Clinical Professional ( RN ) is responsible for the development, implementation and management...clinical nursing experience + Proven work experience as a HEDIS Nurse or similar role in healthcare… more
    CenterWell (08/13/25)
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  • Quality Improvement RN

    CenterWell (Orlando, FL)
    …operational excellence **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) without restriction in Florida + 5+ ... us put health first** The Stars Improvement, Clinical Professional ( RN ) is responsible for the development, implementation and management...clinical nursing experience + Proven work experience as a HEDIS Nurse or similar role in healthcare… more
    CenterWell (08/12/25)
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  • Manager , Utilization Management…

    Evolent (Tallahassee, FL)
    …for utilization management and use of project resources. **Qualifications - Required and Preferred ** + RN Licenses (Active and Unrestricted) - Required + ... with a 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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  • Quality Improvement Supervisor, Clinical

    CenterWell (Port St. Lucie, FL)
    …excellence **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) without restriction in applicable state + ... across the following areas: + Quality/clinical management and population health + HEDIS and Stars performance + Operational improvements + Financial performance and… more
    CenterWell (08/08/25)
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  • Clinical Quality Consultant NP 100% Virtual,…

    Elevance Health (Tampa, FL)
    …of ICD-10 CM, CMS guidelines including Risk Adjustment payment model, STARS and HEDIS highly preferred . + Clinical review experience. Please be advised that ... life through home-care and community based services. **Clinical Quality Consultant Nurse Practitioner** Location: **Virtual** - This role enables associates to work… more
    Elevance Health (08/15/25)
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  • Senior Specialist, Member & Community…

    Molina Healthcare (FL)
    …Certified Professional in Health Quality (CPHQ) + Nursing License ( RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all ... activities and results to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may require remediation + Other… more
    Molina Healthcare (07/31/25)
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