• Manager, Clinical Quality Improvement

    VNS Health (Manhattan, NY)
    …audit team and oversees quality improvement initiatives with a primary focus on Medicare STARS and clinical program performance for VNS Health Plan. Ensures ... You Will Do + Leads the clinical audit team, ensuring compliance with Medicare STARS , HEDIS/QARR, and regulatory requirements. + Develops forms, record… more
    VNS Health (03/13/25)
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  • Director, Quality & Risk Adjustment (New York)

    Molina Healthcare (New York, NY)
    …and federal QI compliance activities. Responsible for local execution supporting Medicare Stars strategies and performance improvement. **Work Location -** ... and VP Stars in developing the local Medicare Stars work plan and executing on...improve CAHPS, HEDIS and HOS scores. Responsible for monitoring Part D and Operational health insurance metrics… more
    Molina Healthcare (04/20/25)
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  • Population Health Pharmacist

    Trinity Health (Clive, IA)
    …appropriate and affordable medication use and oversees pharmacy quality measures related CMS Part D STARS and associated HEDIS measures. The population ... + Minimum of 2 or more years of experience in medication therapy management, Medicare STARS or HEDIS quality measures, managed care pharmacy, or population… more
    Trinity Health (04/19/25)
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  • Manager, Grievance and Appeals, RN

    VNS Health (Manhattan, NY)
    …one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Part D , or Select Health to ensure compliance ... staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health product lines. * Ensure Compliance: Stay… more
    VNS Health (03/05/25)
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  • Director of Pharmacy Quality and Operations…

    Martin's Point Health Care (Portland, ME)
    …and state laws and regulations and applicable accreditation standards + Expert knowledge of Medicare Part D regulations + Proven skills developing high ... Leadership and/or managerial experience Quality Management experience + Knowledge of Medicare Stars and HEDIS quality programs + Knowledge of NCQA accreditation… more
    Martin's Point Health Care (04/16/25)
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