- Molina Healthcare (St. Petersburg, FL)
- …member/ provider ( HEDIS ) outreach and/or quality intervention or improvement studies (development, implementation, evaluation) and Director level experience. ... subject matter expert and lead for Molina Plan quality improvement HEDIS operations using a defined roadmap,...at least 4 years in health plan quality or process improvement or equivalent/related experience. * Operational… more
- Somatus (Mclean, VA)
- …validating HEDIS , medical record reviews_ . Reporting directly to the HEDIS Director , this position will maintain effective communication with internal and ... expert for Policy and Standard Operating Procedures (SOPs) related to HEDIS technical specifications, abstraction, and process intervention. Responsibilities… more
- Centene Corporation (New York, NY)
- …with occasional travel to Bedford, NH!** **Position Purpose:** Lead and direct process improvement activities that provide more efficient and streamlined ... Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set ( HEDIS ) performance. + Ensure health plan is compliant and become/remain… more
- Baylor Scott & White Health (Temple, TX)
- …(MPH, MHA, MBA, or equivalent). * Lean Six Sigma, PMP, or similar project, process improvement certifications. * RN or clinical background. * Experience working ... Note: Benefits may vary based on position type and/or level **Job Summary** The Director of Quality for MA Stars will lead strategic initiatives to achieve and… more
- Sharp HealthCare (San Diego, CA)
- …conjunction with the Director of PHM/ Medical Management and Quality Improvement Director . + Oversees and mentors Medical Directors and Physician Reviewers. ... programs and work plans. + Assists the Chief Medical Officer and the Quality Improvement Director in creating and maintaining a system that gives feedback to… more
- Highmark Health (Pittsburgh, PA)
- …Drives efficient operational functions to achieve established Quality measures, STARS and HEDIS performance ratings. Directs and manages team of ~75 employees that ... as necessary; may have budgetary responsibility and authority. + Quality Improvement Specialist (QIS) Program:Vision and direction for leading embedded coder/… more
- State of Indiana (Indianapolis, IN)
- …mission. Role Overview: As Assistant Director , you will serve as the Director of Quality Improvement (QI), an integral component in serving Medicaid members. ... delivery. You will oversee managed care entities' (MCE) quality management and improvement functions, HEDIS data and scoring, NCQA Accreditation, Annual Quality… more
- Martin's Point Health Care (Portland, ME)
- …leadership in, or focused activity of, a Health Plan (preferred) + Knowledge of process improvement tools + Experience in Health Plan utilization management + ... Place to Work" since 2015. Position Summary The Medical Director (MD) provides clinical leadership and direction to the...MLR , inpatient days/1000, SNF days/1000, and clinical quality improvement (QI) objectives, including HEDIS and how… more
- AmeriHealth Caritas (Philadelphia, PA)
- ; **Responsibilities:** The Medical Director , Utilization Management provides organizational leadership in the operational areas of care management, utilization ... review, appeals, quality improvement and related policy and practice initiatives in collaboration...and practice initiatives in collaboration with the Corporate Medical Director (s), Utilization Management and the Vice President, Medical Affairs.… more
- Sharp HealthCare (San Diego, CA)
- …and Chief Medical Officer and reports findings in conjunction with the Quality Improvement Manager. + Participates in the grievance process with the Chief ... in short and long range program planning, total quality management (quality improvement ), and external relationships. Works with all departments of Health Services… more