- Excellus BlueCross BlueShield (Dewitt, NY)
- …Case Management staff, members, and providers. + Provides backup for the Supervisor/ Manager , whenever necessary by: + Participating in the orientation of new staff ... all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS , serving as internal auditor within the group. + Responsible for all aspects of… more
- AmeriHealth Caritas (Charleston, SC)
- **About the job:** The Manager of Provider Network Management manages the Network Management department's and staff's day-to-day activities.; Responsible for ... the Quality Management Department and company-wide quality initiatives such as HEDIS , CAHPS, and NCQA/URAC. + Compiles documentation regarding quality reports and… more
- Pacific Medical Centers (Renton, WA)
- …programs and governance for Department of Health Agency (DHA). The Manager is responsible for organizing governance committees and the development/ maintenance ... in the QI program, including: program management for DHA Clinical performance, HEDIS performance, CAHPS performance and quality projects. As the organization grows,… more
- CVS Health (Dover, DE)
- …is an individual contributor role**_** **Position Summary** The Sr. Manager , Value-based Contracting is responsible for establishing and maintaining productive ... to obtain crucial or required information from providers, such as HEDIS , Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information… more
- Molina Healthcare (Scottsdale, AZ)
- **JOB DESCRIPTION** **Job Summary** The Manager , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key ... sources. + Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare… more
- Catholic Health (Springville, NY)
- …SKILL AND ABILITY + Knowledge of Patient Centered Medical Home, with MIPS, HEDIS requirements preferred + Strong knowledge of Medical Billing & Third party payer ... requirements + Computer proficiency in Microsoft Office + Ability to adapt to various software applications as necessary + Prior experience with computerized scheduling applications a plus + Strong Verbal & Written Communication skills + Strong knowledge of… more
- Centene Corporation (Indianapolis, IN)
- …applicable regulatory and compliance standards, such as Medicare Star ratings, NCQA HEDIS measures, and Medicaid regulations, etc. + Oversee and/or develop clinical ... recommendations and guidelines for approval by the Pharmacy and Therapeutics committee or MCO DUR Board. + Serve as chairperson for the Clinical Programs/DUR Committee for regulatory oversight and the Clinical Programs/DUR Governance Committee + Monitor… more
- Molina Healthcare (GA)
- …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
- Centene Corporation (Queens, NY)
- …differences between Risk and Value-Based contractual arrangements. + Responsible for understanding HEDIS and STARS measures and partners with Quality Team to drive ... improvement of quality provider performance. + Plans, prepares and executes effective group meetings/discussions with proper objectives and outcomes. + Ensures adherence to contractual obligations and to regulatory requirements. + Identifies areas of… more
- Trinity Health (Boise, ID)
- …Quality Performance Improvement initiatives (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at one of our ... PHMA work includes supporting system-wide quality performance goals for HEDIS and STAR measures. This role reports to the...and STAR measures. This role reports to the SAMG Manager of Quality Performance Improvement, Population Health. + This… more