- CenterWell (Bismarck, ND)
- …as possible. **Responsibilities:** . Act as a collaborating physician for nurse practitioners or physician assistants, including completing regular chart review ... . Meet with clinic leaders about quality of care, review of outcome data, policy, procedure, and records issues....Knowledge of Medicare guidelines and coverage . Knowledge of HEDIS quality indicators . Experience working in value-based care… more
- AmeriHealth Caritas (Manchester, NH)
- …standards. In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and knowledge of Health Plan Rating ... This position is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing of care… more
- Molina Healthcare (Sioux City, IA)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
- Dignity Health (Bakersfield, CA)
- …the needs and barriers in collaboration with providers. - Performs medical record review or audits as needed. - Document provider, clinic staff, member, and/or ... of relevant clinical experience. - Clear and current CA Licensed Vocational Nurse (LVN) license. - Graduate of an accredited vocational/practical nursing program. -… more
- MyFlorida (St. Petersburg, FL)
- …in all aspects of their work. The OPS Advanced Practice Registered Nurse Specialist is responsible for providing comprehensive health care to clients, including ... + Participate in quality assurance activities including meetings and peer review . + Ensure cooperation and coordination between Clinical Services Division, Disease… more
- Humana (Madison, WI)
- …raise the bar for excellence. Key responsibilities include: + Oversees HEDIS , CAHPS, Star ratings, and other State-required measure reporting and evaluation. ... skills to make an impact** **Required Qualifications** + Registered Nurse (RN), physician or physician's assistant licensed in the...by the American Board of Quality Assurance and Utilization Review Providers. If the candidate does not possess one… more
- CenterWell (Savannah, GA)
- …intent Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: + Maintaining ... inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... Social Work, Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse , Medical Director, Pharmacist, Geriatrics, etc.) to ensure continuity and… more
- Veterans Affairs, Veterans Health Administration (Kenosha, WI)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... (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… more