Hedis Review Nurse Jobs in the United States
Fast Pace Health
Talbott, TN
License and DEA must be active, in good standing, and verifiable with the proper regulatory agency; Primary Care Providers must be able to treat all ages and must meet any credentialing requirements needed; and DOT certification required to be obtained within 120 days of employment and maintained during employment. They must have the ability to respond quickly and accurately to changes in condition or response to treatment and is responsible for providing outstanding patient service within the clinic and through various virtual communication channels, while maintaining a compassionate and welcome atmosphere.
Fast Pace Health
Dyer, TN
License and DEA must be active, in good standing, and verifiable with the proper regulatory agency; Primary Care Providers must be able to treat all ages and must meet any credentialing requirements needed; and DOT certification required to be obtained within 120 days of employment and maintained during employment. They must have the ability to respond quickly and accurately to changes in condition or response to treatment and is responsible for providing outstanding patient service within the clinic and through various virtual communication channels, while maintaining a compassionate and welcome atmosphere.
Harbor Community Clinic
$125000 - $160000
San Pedro, CA
Actively participate in Harbor Community Clinic’s peer-review and quality assurance activities to improve HEDIS, UDS and other quality metrics, including timely access to prenatal care, post- partum care, cervical cancer screening, breast cancer screening, immunization rates etc. The Primary Care NP/PA works as a member of an interdisciplinary health care team to provide quality comprehensive primary and preventive care to Harbor Community Health Centers (HarborCHC) patient.
Harbor Community Clinic
$125000 - $160000
San Pedro, CA
Actively participate in Harbor Community Clinic’s peer-review and quality assurance activities to improve HEDIS, UDS and other quality metrics, including timely access to prenatal care, post- partum care, cervical cancer screening, breast cancer screening, immunization rates etc. The OBGYN/Women’s Heath NP/PA works as a member of an interdisciplinary health care team to provide direct patient care in the OB/GYN department, including prenatal, postpartum, and gynecological care to Harbor Community Health Centers (HarborCHC) patient.
HarmonyCares
Elyria, OH
The Medical Pod Leader will be the clinical leader responsible for the clinical performance of clinical pod team members – to include: Accurate diagnosis and documentation, quality, patient experience, affordability, patient safety, clinical team dynamics, and provider productivity. Collaborate with clinical team members associated with pod (Community Health Workers, Medical Social Workers, Nurse Navigators, Care Managers, Patient Care Coordinators, etc.).
Providence St. Joseph Health
Renton, WA
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.
Kinetic Personnel Group, Inc.
Ontario, CA
Requirements: Three (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Alura Workforce Solutions
Rancho Cucamonga, CA
REQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Alura Workforce Solutions
Rancho Cucamonga, CA
REQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Alura Workforce Solutions
Rancho Cucamonga, CA
REQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Alura Workforce Solutions
Rancho Cucamonga, CA
REQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Alura Workforce Solutions
Rancho Cucamonga, CA
REQUIREMENTSThree (3) or more years in healthcare administration in the areas of Utilization Management, Care Management, Quality Improvement or Quality Assurance, where medical record review, preferably in an HMO or managed care setting, is required. Research and develop training materials, conduct presentations and information sessions, or provide targeted outreach about Historical Supplemental Data, NCQA HEDIS Technical Specifications, and other quality activities/medical record review projects.
Allmed Staffing Inc
San Antonio, TX
Evaluates the quality and completeness of clinical gap closures by performing quality reviews with patients, maintaining clinical documentation, and accurately records of their review activities. 4. Conduct a high volume of outbound calls to members to discuss reasons for non-compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers.
UnitedHealth Group
New Braunfels, TX
Seeking a Licensed Vocational Nurse (LVN/LPN) to ensure quality and compliance in HEDIS/STARs measures in San Antonio, Texas, based in New Braunfels. Skills include strong attention to detail, excellent communication, and knowledge of HEDIS/STARs metrics.
UnitedHealth Group
Boerne, TX
We are seeking a Licensed Vocational Nurse (LVN/LPN) specializing in Quality HEDIS/STARs to join our team in Boerne, Texas, near San Antonio. Skills include strong attention to detail, knowledge of HEDIS/STARs measures, and excellent communication skills.
Alura Workforce Solutions
Rancho Cucamonga, CA
Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and departments on HEDIS improvement related issues, serving as a resource for internal and external customers. Maintains summarized information for Quality Systems related to modified and new regulatory requirements for medical management from DHCS, DMHC and CMS.Responsible for understanding current HEDIS technical specifications with the ability to interpret changes and clarifications accurately.
Alura Workforce Solutions
Rancho Cucamonga, CA
Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and departments on HEDIS improvement related issues, serving as a resource for internal and external customers. Maintains summarized information for Quality Systems related to modified and new regulatory requirements for medical management from DHCS, DMHC and CMS.Responsible for understanding current HEDIS technical specifications with the ability to interpret changes and clarifications accurately.
Alura Workforce Solutions
Rancho Cucamonga, CA
Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and departments on HEDIS improvement related issues, serving as a resource for internal and external customers. Maintains summarized information for Quality Systems related to modified and new regulatory requirements for medical management from DHCS, DMHC and CMS.Responsible for understanding current HEDIS technical specifications with the ability to interpret changes and clarifications accurately.
Alura Workforce Solutions
Rancho Cucamonga, CA
Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and departments on HEDIS improvement related issues, serving as a resource for internal and external customers. Maintains summarized information for Quality Systems related to modified and new regulatory requirements for medical management from DHCS, DMHC and CMS.Responsible for understanding current HEDIS technical specifications with the ability to interpret changes and clarifications accurately.
Kinetic Personnel Group, Inc.
Ontario, CA
The HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and departments on HEDIS improvement related issues, serving as a resource for internal and external customers. A permanent position does include excellent retirement pension (CalPERS), ~10% yearly bonus, 6% contribution 453b and excellent government benefits including a generous Holiday/PTO schedule.
Axelon Services Corporation
Not Available, AR
Nice to haves: quality improvement, medical coding, data analytics, and compliance understanding Candidate Requirements Required: Bachelor s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience. Position Purpose: Arkansas Quality Team needs staff to assist with End of Year Push projects to increase gap closure rates.
Axelon Services Corporation
Tacoma, WA
Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality Story Behind the Need Business Group & Key Projects Health plan or business unit . 1 Strong HEDIS skills and Work Ethic 2 At least 3 years experience with HEDIS 3 Ability to work in a remote environment and complete set goals to drive results
HJ Staffing
Philadelphia, PA
Working under the direction of the Manager of Medical Record Review Operations, you will be responsible for performing medical record abstraction and overread in support of Quality reporting (annual HEDIS and State EQRO). Data Management: Utilize specialized software applications to accurately enter chart audit results into the database and provide real-time feedback.
Molina Healthcare
$21.82 - $51.06
Vancouver, WA
Assists with projects and process improvement initiatives + Mentors entry level Abstractors **Job Qualifications** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** Bachelor's degree or equivalent experience **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E/KNOWLEDGE, SKILLS & ABILITIES:** + 3 years experience in healthcare Quality/HEDIS specific to medical record review and abstraction + Intermediate knowledge and understanding of HEDIS projects **PR** **E** **FE** **R** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + At least 3 years of medical record abstraction experience + 3+ years managed care experience. + As needed, may collects medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
Waterfall Technology Consulting Partners
$37.68 - $78.35
Los Angeles, California
In this role, you will support all Medical Group Health Education & Disease Management Programs utilizing established interventions, performing necessary surveys acting as the primary liaison between providers and office staff and Health Plans to facilitate appropriate Health Education opportunities. Additionally, you will perform HEDIS related activities, Pay for Performance activities, Provider Access and Availability Surveys (PAAS), investigates and resolves access-related patient issues, and develops QI reports and action plans, as necessary.
The Christ Hospital Health Network
Norwood, OH
Communicate and collaborate regularly with internal and external healthcare teams inclusive of providers, office staff, nurse care manager, social workers, behavioral health counselors, as well as with the assigned payer liaison team. YEARS OF EXPERIENCE: Minimum of 2+ years of experience in a healthcare or payer setting, with a focus on patient outreach, customer service or care coordination is required.
Inland Empire Health Plan
$91249.6 - $120910.4
Rancho Cucamonga, California
Reporting to Director of Hospital Relations, the Quality Improvement, RN will facilitate quality improvement initiatives across the continuum of care (i.e. acute care hospitals, skilled nursing facilities, hospice agencies, etc.) to enhance the overall quality of care delivered to members. Coordinate activities to foster good working relationships with contracted hospitals, skilled nursing facilities, hospice agencies, providers, and other external partners to encourage their participation in quality improvement groups.
Hackensack Meridian Health
Edison, New Jersey
Responsibilities: A day in the life of a nurse (RN) at Hackensack Meridian Health includes: Effective provides/facilitates the following education & advocacy support: Education: Complete needs assessment, formulate and carry out a comprehensive teaching program -Promotes patient engagement, self-management, and shared decision making -Establishes relationship with patients and caregiver, if any -Translate care choices and treatment plans . Identify high-risk patients, assess clinical and psychosocial needs, make referrals to ancillary providers (disease management, pharmacy, social work, palliative care, community-organizations, non-clinical services), develop care plan in coordination with PCP, engage and activate patients .
Hackensack Meridian Health
Tinton Falls, New Jersey
Responsibilities: A day in the life of a RN, Community Based Care Management at Hackensack Meridian Health includes: Works closely with physicians in all specialties to develop and execute patient care plans and coordinate communications & referrals with care team members & settings of care on behalf of patients. The RN, Community Based Care Management provides direct support to physician practices and identifies complex patients or patients with targeted conditions who require care management, coaching, education, supervision, and/or support.
Elevance Health
San Juan, PR
Currently, MMM Holdings, LLC operates in Puerto Rico under Elevance Health, Inc. a leading health company dedicated to improving the quality of life of communities in the United States. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Partnership HealthPlan of California
$103059.95 - $133977.94
Fairfield, California
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. Provider Preventable Conditions (PPCs) and ensures that appropriate notification is sent. to appropriate Partnership departments and DHCS Audits & Investigations Unit (A&I).
The Oncology Institute of Hope and Innovation
$91574.53 - $109817.82
Cerritos, CA
The ASCO QOPI Nurse Quality Specialist leads quality and safety efforts for outpatient oncology practices with a primary focus on the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI), and the QOPI Certification Program. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations.
ERP International
Barksdale AFB, LA
Provides comprehensive primary, preventative, and therapeutic health care service to patients and family members empaneled to the MTF; to included, but not limited to, the Flight and Operational Medicine Clinic, Occupational Health Clinic, Base Operational Medicine Clinic, Family Health Clinic, or other privileged Nurse Practitioner positions within the MTF. Ensure Service Members have access to comprehensive counseling on the full range of methods for contraception, pregnancy, pregnancy prevention and menstrual suppression, as applicable and directed by DHA-PI and prescribe specific deployment medications as indicated by Public Health and deployment location.
Fuze Health
$38 - $40
Hayward, CA
Active, non-restricted compact state nursing license with primary state of licensure in one of the following: Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Guam, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, or Wyoming. Employees are also provided flexible vacation time, accrued paid sick time, 10 paid holidays, (2 floating holidays for full time non-exempt employees) , and eight weeks of paid parental leave for eligible employees, additional paid weeks for the birthing parent, 4 weeks paid caregiver leave, and a Lifestyle Spending Account allowance each month.
CINQCARE
$72000 - $85000
Atlanta, GA
This role partners closely with practice champions and care teams to improve clinical quality, patient-centered care delivery, operational workflows, and total cost of care for defined populations. Provide education and coaching on clinical documentation, ICD-10/CPT coding accuracy, risk adjustment, and population health management activities (e.g., Transitions of Care, Annual Wellness Visits, diagnostic attestation).
CINQCARE
$65000 - $85000
Buffalo, NY
Collaboration: The Primary Care RN Coordinator will ensure that nursing capabilities form a cohesive offering, including by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve the business objectives of Care Medical Practice PLLC. The Primary Care RN Coordinator reports directly to the (Director of Clinical Operations) administrator and plays a vital role in providing exceptional direct nursing care, optimizing patient outcomes, and coordinating key clinical operations within our primary care office setting.
Partners for Quality
Robinson Township, Pennsylvania
Utilize the electronic health record to assure health care summaries including monthly progress notes for children in the MCC life sharing program and people supported in the life sharing program, Medication Administration Records (MARs), medical/nursing notes, social medical histories, and other medical documentation within medical records are accurate and current. This position will require travel to the homes of people supported for home visits and will have the flexibility to telework from home on a Citizen Care device as well as in the administrative office when not in the field as scheduled with the Life Sharing Medical Coordinator.
Astrana Health, Inc.
$150000 - $170000
San Bernardino, California
The Nurse Practitioner will work collaboratively with other healthcare professionals to deliver patient-centered care that focuses on keeping patients healthy at home throughout the San Bernardino area, enhancing patient outcomes, and improving quality of life for homebound and complex patients. The ideal candidate will have expertise in managing patients with complex medical conditions in a home care setting, ensuring high-quality care for individuals who are considered high-risk due to chronic illnesses, multiple comorbidities, and complex healthcare needs.
Astrana Health, Inc.
$150000 - $180000
San Francisco, California
The Nurse Practitioner will work collaboratively with other healthcare professionals to deliver patient-centered care that focuses on keeping patients healthy at home throughout the San Francisco area, enhancing patient outcomes, and improving quality of life for homebound and complex patients. The ideal candidate will have expertise in managing patients with complex medical conditions in a home care setting, ensuring high-quality care for individuals who are considered high-risk due to chronic illnesses, multiple comorbidities, and complex healthcare needs.
Astrana Health, Inc.
$150000 - $170000
Antelope Valley, California
The Nurse Practitioner will work collaboratively with other healthcare professionals to deliver patient-centered care that focuses on keeping patients healthy at home throughout the Antelope Valley area, enhancing patient outcomes, and improving quality of life for homebound and complex patients. The ideal candidate will have expertise in managing patients with complex medical conditions in a home care setting, ensuring high-quality care for individuals who are considered high-risk due to chronic illnesses, multiple comorbidities, and complex healthcare needs.
Judge Group
Orlando, FL
You’ll work closely with a registered nurse and collaborate with each patient’s primary care provider to identify red flags, manage chronic conditions, and keep patients healthy at home. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes.
American TrueCare, Inc.
$90000 - $100000
San Diego, CA
The position is responsible for assessing patients' needs and developing an executable plan to help patients navigate the social barriers to achieving good care, The position will work closely with Health care liaisons to ensure plan of care is executed and patient receive the right care at the right time with the right outcome and right patient experience. 2-3 years of experience providing home health and/or social services case management services to low-income populations with one or more of the following: complex chronic conditions, high utilizer of emergency room and tertiary health care services, severe mental illness, and/or homelessness.
CareSource
$62700 - $100400
Battle Mountain, NV
Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing to complete health and psychosocial assessments through a health equity lens unique to the needs of each member that identify the cultural, linguistic, social and environmental factors/determinants that shape health and improve health disparities and access to public and community health frameworks. The Community Based Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population through culturally competent delivery of care and coordination of services and supports.
Iconma
Grand Rapids, MI
Conduct in-state provider educational sessions in person and virtually on relevant topics such as new business tools, billing/coding, Health e-Blue (HeB), HEDIS, medical record reviews, etc. Assist leaders in monitoring issues, projects, timelines, and plans related to various corporate initiatives impacting providers.
Judge Group
$125000 - $135000
Niagara Falls, NY
We are seeking a dedicated Nurse Practitioner or Physician Assistant to provide comprehensive, longitudinal primary care services to patients in their homes and community-based settings, including assisted living facilities, skilled nursing facilities, and group homes. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes.
AHMC Healthcare
Whittier, California
Is a clinical resource to admitting department and provides ongoing education on the effective resources of the Pre Admission Case Manager and Quality/Case Management Department to physicians, physician office staff, nursing. Oversees that Pre-Admit TAR's are obtained and the patients payer sources have the appropriate network among the patients health care team (i.e. Case Mgmt, Business Office, Physicians, Social Services, Nurse Manager, etc.).
Judge Group
$43 - $45
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By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. A healthcare organization is seeking an experienced Clinical Nurse Specialist (RN) to support clinical quality operations, including HEDIS®, DSNP, and medical record review activities.
Judge Group
Maricopa, AZ
We are seeking an experienced Nurse Practitioner (NP) to provide comprehensive primary care services to patients in home-based and community settings in Mesa, Tempe, or Gilbert, Arizona. The ideal candidate will play a crucial role in delivering high-quality, patient-centered care, promoting continuity of care, and improving overall patient outcomes.
Judge Group
Maricopa, AZ
The ideal candidate will play a crucial role in delivering high-quality, patient-centered care, promoting continuity of care, and improving overall patient outcomes. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes.
Humana
$78400 - $107800
Orlando, FL
The Senior Stars Improvement, Clinical Professional works directly with provider groups, Management Services Organizations (MSOs) and organizational leaders to impact Centers for Medicare & Medicaid Services (CMS) Star Rating categories - including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), Patient Safety, and Patient Experience. To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.