- CenterWell (San Antonio, TX)
- …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 + Bilingual in English and Spanish **Additional Information:** +… more
- CenterWell (Anderson, 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
- Centene Corporation (Lansing, MI)
- …of the following areas: claims, provider data, member data, clinical data, HEDIS , pharmacy, external reporting + Extract, load, model, and reconcile large amounts ... of data across multiple system platforms and sources + Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement… more
- CenterWell (Alice, TX)
- …protocol defined byClinical Leadership. + Meets with RMD about quality of care, review of outcome data,policy, procedure and records issues. + Participates in ... Number + Knowledge of Medicare guidelines and coverage + Knowledge of HEDIS quality indicators **Additional Information:** + Guaranteed base salary + bi-annual bonus… more
- CenterWell (Delray Beach, FL)
- …defined by Clinical Leadership. + Meets with AMD 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 (Louisville, KY)
- …guidance and expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to meet the quality and cost expectation ... environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice coding and documentation… more
- CenterWell (Las Vegas, NV)
- …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** + Guaranteed base salary + biannual… more
- 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