- 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
- 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
- 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
- Molina Healthcare (Layton, UT)
- … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... necessity. + Participates in and maintains the integrity of the appeals process , both internally and externally. Responsible for the investigation of adverse… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …is right for you, we encourage you to apply! Job Description: The Medical Director participates in the broad array of activities of the Medical Services area ... medical policies, guidelines and medical criteria. + Assists with training medical director colleagues and nursing staff , including leadership of teaching grand… more
- CenterWell (Orlando, FL)
- …caring community and help us put health first** The Associate Operations Director (AOD) leads Senior Focused Primary Care clinical operations in a multi-physician ... achieve optimal patient outcomes and company initiatives, including Quality, HEDIS /STARs, AHCA, optimal patient scheduling, financial management, patient engagement,… more
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