• Director , Quality Improvement

    Humana (Baton Rouge, LA)
    …a part of our caring community and help us put health first** The Director , Quality Improvement implements quality improvement programs for all lines ... business including annual program description, work plan, and annual evaluation. The Director , Quality Improvement requires an in-depth understanding of how… more
    Humana (04/29/25)
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  • Medicaid Quality Management Health Plan…

    Elevance Health (Woodbridge, NJ)
    …management skills. + Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet ... **Medicaid Quality Management Health Plan Director ** **Preferred Location: Iselin, NJ.** This role requires...quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement , NCQA accreditation… more
    Elevance Health (04/23/25)
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  • Senior Medical Director - Sharp Health Plan

    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
    Sharp HealthCare (04/20/25)
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  • Associate Director , Data Quality/Integrity…

    Humana (Phoenix, AZ)
    Director , Data Quality/Integrity will lead and manage the HEDIS Supplemental Data operations. This includes executing, maintaining, and continuously improving ... Health Team to assist in problem resolution. + Work with the internal Continuous Improvement team to integrate process improvements and influence technical and … more
    Humana (05/06/25)
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  • REMOTE - Associate Medical Director

    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
    Martin's Point Health Care (04/19/25)
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  • Medical Director Specialty Medical Services…

    Molina Healthcare (Seattle, WA)
    … activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to Medicare, ... **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to the… more
    Molina Healthcare (04/20/25)
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  • Director of Pharmacy Quality and Operations…

    Martin's Point Health Care (Portland, ME)
    …and service delivery channels. + Develops, implements, and ensures continuous quality improvement and process improvement to deliver effective and ... + Knowledge of NCQA accreditation + Experience leading accreditation and clinical process improvement efforts + Experience managing operational or project… more
    Martin's Point Health Care (04/16/25)
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  • Medical Director Utilization Management…

    AmeriHealth Caritas (Newtown Square, PA)
    …more about us at www.amerihealthcaritas.com. **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 with the Corporate Medical … more
    AmeriHealth Caritas (04/11/25)
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  • Associate Operations Director

    CenterWell (Olathe, KS)
    …caring community and help us put health first** The Associate Operations Director , Clinic/Center Administration, plans and directs the work of professional and ... outpatient care to patients in a clinical setting. The Associate Director , Clinic/Center Administration requires a solid understanding of how organization… more
    CenterWell (04/18/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Dayton, OH)
    … 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
    Molina Healthcare (05/02/25)
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