- AmeriHealth Caritas (Philadelphia, PA)
- …organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and practice initiatives ... standards of high quality, especially the performance standards embodied in the HEDIS program. + Assuring a high-performing Medical Management system that adheres to… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Management and other Medical Management programs. + Develop reporting on NCQA HEDIS and other quality measures. + Build and maintain client-facing reports, ... dashboards, and analyses. + Lead program performance review presentations with clinical program managers, client account managers, and external clients, as needed. +… more
- Tiburcio Vasquez Health Center (Hayward, CA)
- …HR to actively engage and manage provider retention, recruitment, peer review , performance improvement plans, and succession planning. Compliance, Risk Management ... + Oversees internal clinical audits and external reporting to HRSA, UDS, HEDIS , and managed care plans. + Oversee the Credentialing and Privileging department… more
- CenterWell (Spartanburg, SC)
- …protocol defined byClinical Leadership. + Meets with RMD about quality of care, review of outcome data,policy, procedure and records issues. + Participates in ... setting + Knowledge of Medicare guidelines and coverage + Knowledge of HEDIS quality indicators + Bilingual is a plus **Additional Information** **Why CenterWell**… more
- Covenant Health Inc. (Knoxville, TN)
- …the patient that will meet identified needs. + Facilitates timely documentation review with the Clinical Documentation Improvement (CDI) specialist, as necessary to ... care. + Stays abreast of most recent changes in quality related to HEDIS measures, CMS Conditions of Participation, MIPS and other regulatory requirements to assist… more
- St. Mary's Healthcare (Amsterdam, NY)
- …other departments including physicians and nursing staff. . Participates in process review and improvement meetings. . Makes crucial decisions to achieve success by ... with the Compliance and Privacy Officer. . Oversees insurance, auditing reviews (ie, HEDIS and /Risk Adjustment), to ensure staff is completing requests in a timely… more
- CenterWell (Savannah, GA)
- …in resolution of inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and identifying ... environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation… more
- CenterWell (Charleston, SC)
- …defined by Clinical Leadership. + Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. + Participates in potential ... of Medicare guidelines and coverage + Bilingual is a plus + Knowledge of HEDIS quality indicators **Use your skills to make an impact** **Required Qualifications** +… more
- Catholic Health Services (Melville, NY)
- …new staff. Participates in staff meetings and huddles as appropriate. Participates in Hedis , GPRO, and other quality programs as needed Enters provider orders into ... the electronic record for provider review and signature Preforms AWV Patient counseling and instruction on health maintenance goals Position Requirements and… more