- Good Samaritan (Sioux Falls, SD)
- …and required reporting. Will perform healthcare effectiveness data and information set ( HEDIS ) record reviews and assist with clinical questions related to chart ... of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department… more
- Molina Healthcare (Tampa, FL)
- …Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial ... policy/procedure development, provider contracting experience. + Experience with NCQA, HEDIS , Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice,… more
- Veterans Affairs, Veterans Health Administration (Kenosha, WI)
- …(DPC) with responsibility for their respective clinic(s), and in collaboration with the Nurse Manager is responsible for all daily operations. It is the intent that ... quality outcomes, care coordination, screenings), Healthcare Effectiveness Data and Information Set ( HEDIS ), All Employee Survey scores, and other metrics as to be… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …subject matter experts on coding accuracy and Quality programs such as including HEDIS and Stars. Your Responsibilities As part of a Blue Cross provider-performance ... (CPHQ) or Certification in Health Care Quality and Manager (CHQM) * Registered Nurse * Solid knowledge of Medicare Advantage Business Compensation and Benefits: Pay… more