Hedis Review Nurse $100,000 jobs

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RN, Registered Nurse - Vice President, Quality Improvement
Infinity MedStaff - Sacramento, CA
Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set...
Sponsored by NurseJobsNationwide.com - 4 days ago
Medical Director - 99862SY
Anthem, Inc. 530 reviews - Indianapolis, IN
Participates in risk management, claims adjudication, utilization management, case review, education and outreach programs, HEDIS reporting, credentialing, peer...
Sponsored by Anthem, Inc. - 1 day ago
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Manager - Quality Improvement

Highmark Health 5 reviews - Pittsburgh, PA
Oversee and lead the organization-wide HEDIS Business Process within Gateway Health Plan, which includes HEDIS, CAHPS and HOS....

Director of Clinical Services (Associate...

Stanislaus County 16 reviews - Modesto, CA
Prior exposure to compliance, quality assurance measurements, including HEDIS; Initiate and lead or participate, as appropriate, in the evaluation and review of...

Director, Utilization Management Regulatory Compliance

Evolent Health - Arlington, VA
Registered Nurse with current unrestricted license preferred. Responsible for leading utilization management readiness reviews and government audits....
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Quality Director, HEDIS

Altegra Health 62 reviews - Alpharetta, GA
Active nursing license (Provider, Registered Nurse or Licensed Practical Nurse) preferred; Ability to speak to HEDIS measure abstraction and quality assurance....

Director of Quality Improvement and Program Management

BMC HealthNet Plan and Well Sense - Boston, MA
Reviews and edits documentation (e.g. Including HEDIS, P4P, CAHPS, and CMS is required. Provides leadership for all activities relating to the development and...

QUALITY REVIEW SPECIALIST

Presence Health 45 reviews - Illinois
Complete ambulatory medical record reviews against internal and external performance measures and accreditation standards to ensure they are complete and meet...

Quality Manager- Government Programs (Cigna Medical Group)

Cigna 817 reviews - Phoenix, AZ
Licensed Registered Nurse preferred. Demonstrated understanding of NCQA and HEDIS requirements. Reviews, maintains and updates MAP Quality P&Ps and Job Aids in...

East Central Regional Medical Director

Humana 827 reviews - Dublin, OH
Oversee Quality Improvement Department with QI Director as direct report and monitor QI Nurses on HEDIS/STARS metrics improvement with PCP offices and IPAs....

Appeals Nurse

Pathway Medical Staffing - Rahway, NJ
Meets with utilization review (UR) committee to review all outlier cases and provide continued care approval and denial status....

Medical Director

Molina Healthcare 118 reviews - San Antonio, TX - +2 locations
Reviews cases with concurrent review nurses. Reviews quality referred issues, focused reviews and recommends corrective actions....
Director of Quality Improvement and Program Management
BMC HealthNet Plan and Well Sense - Boston, MA
Reviews and edits documentation (e.g. Including HEDIS, P4P, CAHPS, and CMS is required. Provides leadership for all activities relating to the development and...
Sponsored by Boston Medical Center HealthNet Plan - 30+ days ago
Medical Director
Molina Healthcare 118 reviews - Charleston, SC
Reviews cases with concurrent review nurses. Reviews quality referred issues, focused reviews and recommends corrective actions....
Sponsored by Molina Healthcare - 30 days ago
Medical Director for Medical Claims and Code Edit Review
Molina Healthcare 118 reviews - Long Beach, CA
Reviews cases with concurrent review nurses. Reviews quality referred issues, focused reviews and recommends corrective actions....
Sponsored by Molina Healthcare - 30+ days ago

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Company with Hedis Review Nurse $100,000 jobs
530 reviews
Anthem, Inc. is one of the nation's leading health benefits companies with nearly 69 million people served by its affiliated companies.