- Veterans Affairs, Veterans Health Administration (Chesapeake, VA)
- …care team (LPN, RN, Clinician/Provider, Social worker, Pharmacist, etc.). to review the clinic utilization by using various report clinic utilization statistical ... (CTM), recall delinquency report, secure messages, VeTEXT, VAR, as well as SAIL/ HEDIS metrics that directly impact the PACT team's metrics for patient care. Other… more
- Elevance Health (Independence, OH)
- …health needs to reduce disparities and improve outcomes among high-risk sub-populations. + Review data dashboards, analytics, HEDIS , CAHPS and other data reports ... resources, timelines, and compliance requirements. + Contribute to the preparation, review , and timely submission of required regulatory reports; ensure program… more
- 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
- ZoomCare (Tigard, OR)
- …our values: Awesome, Creative, Respectful, Team Players, Get it Done. + Review outpatient clinical documentation to identify gaps in specificity, clarity, and ... and common disease processes necessary for accurate code assignment and documentation review . + Proficiency in working with electronic health record (EHR) systems… 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
- CenterWell (Fort Worth, TX)
- …experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in care, ensuring clinical ... experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals *Personally deliver high-quality primary 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