UNKNOWN

FEED

Assess and interpret medical and psycho-social histories; perform physical examinations (including gynecological and breast examination as appropriate; identify problems; formulate a plan of treatment; provide education and referral (as indicated); and evaluate the effectiveness of the interventions prescribed. Refer patient to other available services/specialist to meet needs where appropriate Examine patients, formulate differential diagnostic plans, and define and order required diagnostic testing.

DAP Health Inc

Certified Nurse Midwife

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The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with the members' care including clinical nurses and treating physicians. Recognize the client's right to self-determination as it relates to the ethical principle of autonomy, including the client/family''s right to make informed choices that may not promote the best outcomes, as determined by the healthcare team.

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry.  We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Blue Cross and Blue Shield Association

Care Management - Nurse, Senior (FEP - Triage)

Chairs collaborative workgroups to develop strategies for effective QI intervention programs; interfaces and supports other medical care management, disease management or care coordination activities; oversees scheduling, execution and follow-up for regulators, physicians, nurses, pharmacists and providers. Serves as the primary contact for interventions, including qualitative analysis, reporting and development of program materials, templates and/or policies; provides ongoing support to manage and maintain the integrity of established programs/processes and member/provider outreach initiatives, and leads the interventions Joint Operations Committee (JOC).

Molina Healthcare Inc

Director, National Quality Interventions (Member Programs) - REMOTE

Utilize the AIDET communication framework to communicate with patients and team members in a manner that reduces patient anxiety, increases patient compliance, and improves clinical outcomes. Principal Responsibilities: Performs routine (noninvasive) patient care functions as prescribed by licensed healthcare personnel, following established clinic policies and procedures within the defined scope of education, training, and responsibilities.

JWCH Institute Inc

Medical Assistant

At least 3 years of experience with HEDIS and Surveys for example, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS), Consumer Assessment of Healthcare Providers and Systems Medicare Advantage and Prescription Drug Plan (CAHPS- MAPD), Qualified Health Plan Enrollee Experience Survey (QHP-EES), Health Outcome Survey (HOS), etc. Staff support and administration; Works with staff to set up incentive goals, and work metrics; Monitors activity to assure staff are engaged; Works with the technical staff to develop databases for data capture and reporting; Conducts verbal or written counseling, writes performance improvement plans, and resolves issues impacting productivity.

YEAR

L.A. Care Health Plan

Manager, Quality Data

At Included Health, the Associate Clinical Director, Integrated Care Quality (NP/MD) is responsible for the strategy, external representation, and program leadership needed to ensure our clinical services perform credibly in high-stakes client, consultant, and audit-facing settings. The Director will represent Included Health in consequential meetings with clients, consultants, health plans, and internal leaders; shape the vision for external-facing clinical quality work; build trusted relationships; and translate audit and quality findings into durable operational improvement strategies.

Included Health Inc

Associate Clinical Director, Integrated Care Quality (NP/MD)

HOUR

The Coordinator - Integrated Transitional Care is a fast-paced position responsible for the timely processing of authorization requests, verifying member eligibility, and obtaining additional information as requested by the Integrated Transitional Care Nurse. Collaborate with team members regarding member care issues and consult with the Integrated Transitional Care Nurse or management to help ensure the appropriate treatment plan is followed thoroughly and promptly.

Impresiv Health

Coordinator - Integrated Transitional Care

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Under the direction of the Vice President of Compliance, and in close partnership with the Special Investigations Unit (SIU) Manager, the SIU Medical Record Audit Manager provides leadership and strategic direction for IEHP's prepayment and post-payment medical record audit functions within the Fraud, Waste, and Abuse (FWA) framework. The SIU Medical Record Audit Manager oversees and develops a team of Medical Record Auditors, directing complex coding and documentation audits of medical records and claims to determine the accuracy, appropriateness, and compliance of billed services under federal and state requirements applicable to each line of business.

Inland Empire Health Plan

Manager, Special Investigations Unit Medical Record Audit

We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions.

Clinica Sierra Vista

Medical Assistant I - Float - Elm CHC

Essential Functions: Float Medical Assistant must have a working knowledge of all front office, back office, intake, and medical record processes including: Support in maintaining proficiency in the role of Receptionists and Medical Assistant duties and responsibilities. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive.

Medical Assistant I-Float - South Bakersfield CHC

Medical Assistant I-Float - McFarland CHC

Medical Assistant I-Float - Lexington CHC

Medical Assistant I-Float - Family Health Center

Medical Assistant I - Float - Mobile Unit (Fresno)

The Population Health Specialist utilizes population health tools, patient registries, quality reports, and outreach workflows to support HEDIS, STAR, risk adjustment, Annual Wellness Visits, and other quality initiatives while contributing to organizational performance and patient health outcomes. The Population Health Specialist supports Akido’s value-based care strategy by identifying, engaging, and coordinating care for patient populations requiring preventive services, chronic disease management, and care gap closure.

Akido

Population Health Specialist

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Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. Strong knowledge of Patients rights and responsibilities, familiarity with electronic health record (EHR), incident tracking based on grievances and appeals trends, skilled in coordinating case reviews, and ability to develop and monitor quality initiatives strongly preferred.

University Health Services Inc

Lead Quality Risk Management - Grievance/Appeals

Assess and interpret medical and psycho-social histories; perform physical examinations (including gynecological and breast examination as appropriate; identify problems; formulate a plan of treatment; provide education and referral (as indicated); and evaluate the effectiveness of the interventions prescribed. The Advanced Practice Provider works to support the mission and vision of DAP Health by providing excellent patient-centered care and services within a dynamic team environment.

Advanced Practice Provider

Advanced Practice Provider (APP)

Job Summary: Under the direction of the Clinic Manager, the Case Manager works as part of the Enhanced Care Management (ECM) team and Primary Care Provider (PCP) care team to provide high quality, efficient and service oriented patient/member care while demonstrating the health center's core values. The Case Manager works closely with ECM and their care team to organize activities necessary to successfully meet requirements established by managed care plans, HEDIS clinical quality measures and FQHC clinical performance measures.

Camino Health Center

Case Manager

The Manager, MN Quality & Patient Safety is responsible for providing dedicated day-to-day operational and clinical management for the organization''s quality, patient safety, delegated oversight, and physician governance infrastructure for the Cedars-Sinai ambulatory enterprise, including Cedars-Sinai Medical Network and Huntington Health Physicians. Req ID 19766 Working Title Manager, MN Quality & Patient Safety Department MNS Quality Mgmt Business Entity Cedars-Sinai Medical Center Job Category Compliance / Quality Job Specialty Qual Measurement & Reporting Overtime Status EXEMPT Primary Shift Day Shift Duration 8 hour Base Pay $49.43 - $83.04.

<p>Cedars Sinai is one of the largest nonprofit academic medical centers in the United States, and it is the largest private academic medical center in the Western United States. The Cedars Sinai main campus, which encompasses nearly 24 acres, is located at the point where the cities of Los Angeles, Beverly Hills, and West Hollywood meet. Cedars Sinai has been recognized annually by U.S. News & World Report’s top 10 best hospitals in the U.S. The institution most recently placed No. 7 among a select group of 20 Honor Roll hospitals and ranked nationally in a dozen specialties. In addition, Cedars Sinai ranked No. 3 in California and No. 2 in the Los Angeles metro area.</p>
<p>Within Cedars Sinai, the Institute for Research on Health Aging conducts multi-disciplinary research that prioritizes the prevention of cardiovascular disease, neurocognitive disease, and cancer. Our focus is on translating new research discoveries into pragmatic interventions aimed at promoting healthy aging across diverse populations. Our approach involves human physiology, cohort, and clinical trial studies and our team includes established experts in population, clinical, translational, basic, and data science.</p>

Hedis Review Nurse Jobs in California

Certified Nurse Midwife DAP Health Inc

Care Management - Nurse, Senior (FEP - Triage) Blue Cross and Blue Shield Association

Director, National Quality Interventions (Member Programs) - REMOTE Molina Healthcare Inc

Medical Assistant JWCH Institute Inc

Manager, Quality Data L.A. Care Health Plan

Associate Clinical Director, Integrated Care Quality (NP/MD) Included Health Inc

Coordinator - Integrated Transitional Care Impresiv Health

Manager, Special Investigations Unit Medical Record Audit Inland Empire Health Plan

Medical Assistant I - Float - Elm CHC Clinica Sierra Vista

Medical Assistant I-Float - South Bakersfield CHC Clinica Sierra Vista

Medical Assistant I-Float - McFarland CHC Clinica Sierra Vista

Medical Assistant I-Float - Lexington CHC Clinica Sierra Vista

Medical Assistant I-Float - Family Health Center Clinica Sierra Vista

Medical Assistant I - Float - Mobile Unit (Fresno) Clinica Sierra Vista

Population Health Specialist Akido

Lead Quality Risk Management - Grievance/Appeals University Health Services Inc

Advanced Practice Provider DAP Health Inc

Advanced Practice Provider (APP) DAP Health Inc

Case Manager Camino Health Center

Manager, MN Quality & Patient Safety Cedars-Sinai Medical Center

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