- CVS Health (Tallahassee, FL)
- …organization with multiple stakeholders. * Help achieve or exceed all applicable HEDIS , Stars and local state performance targets and goals otherwise specified for ... the plan. Be present for regulatory audits in-person. * Support all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service (grievance) issues. * Actively participate in or lead quality and/or member/provider… more
- Veterans Affairs, Veterans Health Administration (Las Vegas, NV)
- …performance metrics, ensuring compliance with national standards (eg, ORYX, HEDIS , SAIL measures). Collaborate with other departments to implement multi-disciplinary ... approaches to patient care. . Research and Academic Activities: Promote and support clinical research initiatives within the section. Facilitate participation in research projects and clinical trials. Encourage academic writing and publication among the… more
- CVS Health (Trenton, NJ)
- …to obtain crucial or required information from Providers, such as HEDIS , Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information ... with member services and other internal departments. **Required Qualifications** + Minimum of 3 to 4 years recent Managed Care Network Value Based Contacting experience with 2-3 years Medicaid Network experience + Must have Microsoft Office experience with… more
- Molina Healthcare (Tucson, AZ)
- …improvement experience. * Knowledge of Healthcare Effectiveness Data Information Set ( HEDIS ) and National Committee for Quality Assurance (NCQA). * Strong attention ... to detail, critical-thinking, and problem solving skills. * Ability to work cross-collaboratively in a highly matrixed organization. * Time-management skills and ability to multi-task. * Excellent verbal and written communication skills. * Microsoft Office… more
- CenterWell (Charlotte, NC)
- …environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators. **Use your skills to make an impact** **Additional ... Information** + Occurrence-based Malpractice Insurance + Competitive hourly rate + and more \#LI-KS3 \#nursepractitionercareers **Scheduled Weekly Hours** 20 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for… more
- CVS Health (Springfield, IL)
- …possess an understanding of how compliance and quality programs (NCQA and HEDIS ) affect the Plan. + Proficient on credentialing, provider relations (internal and ... external), network development to include adequacy and make up and how that affects the provider experience and medical costs. + High acumen on the marketing of Medicaid, the communications to members and providers, the involvement of community programs and… more
- Mount Sinai Health System (New York, NY)
- …contact for payer quality reporting * Content expertise for standard quality measures ( HEDIS , PQRS, MIPS, etc.) * Interface with analytics, IT, and providers to ... provide high fidelity internal quality reporting * Manage EHR optimization, automated data acquisition, and natural language processing for quality data capture **About Us** **Strength through Unity and Inclusion** The Mount Sinai Health System is committed to… more
- CenterWell (Las Vegas, NV)
- …environment + Knowledge of Medicare guidelines and coverage + Knowledge of HEDIS quality indicators Additional Information Guaranteed base salary + quarterly bonus ... Excellent benefit package - **_health insurance effective on your first day of employment_** CME Allowance/Time Occurrence Malpractice Insurance 401(k) with Employer Match Life Insurance/Disability Paid Time Off/Holidays Minimal call Scheduled Weekly Hours 40… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …(CMS, department of health, etc) and consulting companies. * Experience leading HEDIS data collection and submissions. * Knowledge of statistical software (R or ... SAS). Compensation and Benefits: Pay Range: $132,300.00 - $178,600.00 - $224,900.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job. We offer… more
- Community Health Systems (Naples, FL)
- …years of clinical nursing experience required + 1-2 years of experience in HEDIS , MIPS, PQRS, ACO, STARS programs preferred **Knowledge, Skills and Abilities** + ... Ability to evaluate clinical documentation and make timely, independent decisions regarding medical necessity and care status. + Proficient in utilization review processes, admission criteria, and payer authorization requirements. + Strong interpersonal skills… more