- CVS Health (Lansing, MI)
- …to establish a sustainable competitive business advantage by supporting the plan goals. 2. Review , interpret and analyze data and trends at State level in: UM, CM, ... Have oversight of the design, development, and deployment of Care Models and review medical care provided to Enrollees and medical aspects of the Provider Contract.… more
- Molina Healthcare (Layton, UT)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
- Molina Healthcare (Covington, KY)
- …(clinical operations) teams including Utilization Management (prior-authorization, inpatient review ) and Care Management (case/health management and transition of ... chemical dependency programs. + Continually refines operational processes and champions review of team processes, workflows, and activities. + Articulates project… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …compliance, and cost-effective, clinically sound drug coverage decisions. + Continuously review and adapt to regulatory and accreditation requirements (ACA, WA OIC, ... AK DOI, NCQA, HEDIS ). Support medical management and clinical pharmacy initiatives through...them to drug utilization management, care management activities, product review , and program development. **What you will bring** :… more
- General Dynamics Information Technology (Falls Church, VA)
- …knowledge of Joint Commission standards, Infection Control and other quality measures. + Review raw and synthesized data ( HEDIS , ORYX, TJC, NPIC, NSQIP, AHRQ ... and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and… more
- ERP International (Barksdale AFB, LA)
- …to determine deployment status in a private setting. + Conduct pre-deployment review of health record for any conditions that may impact deployment status. ... + Review the Electronic Health Record (EHR) to identify current...programs and clinical practice guidelines (eg VA/DoD CPGs), and HEDIS Measurements. + Teaches patients and family member's ways… more
- Adelante (Buckeye, AZ)
- …electronic health record. Clinical Collaboration + Collaborate with the clinical team to review and act on Tasks/PTAs sent by providers. + Collaborate with the FM/IM ... as needed per AHC standing orders and procedure. + Review and contact patients regarding normal & abnormal labs...and closure of Healthcare Effectiveness Data & Information Set ( HEDIS ) care gaps of required Quality Metrics. + Coordinate… more
- Datavant (Indianapolis, IN)
- …+ Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. + Familiarity with HIPAA patient privacy requirements. + Excellent ... protected status. To learn more about our commitment, please review our EEO Commitment Statement here (https://www.datavant.com/eeo-commitment-statement) . Know Your… more
- CenterWell (Kissimmee, FL)
- …defined by clinical leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... environment . Knowledge of Medicare guidelines and coverage . Knowledge of HEDIS quality indicators **Additional Information:** . Base salary +bi-annual incentive .… more
- CenterWell (Sarasota, FL)
- …defined by Clinical Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... environment . Knowledge of Medicare guidelines and coverage . Knowledge of HEDIS quality indicators **Additional Information:** . Base salary +bi-annual incentive .… more