UNKNOWN

FEED

This includes coordinating across primary care (PCP) offices and specialty networks, managing electronic prescription requests and pharmacy communications, driving referral workflows, and tracking durable medical equipment (DME), home health care, imaging, and laboratory orders through completion. Desired skills and experience: Proven experience in care coordination and quality metric improvement, particularly assisting Medicare Advantage populations in closing STARS/HEDIS preventive care gaps (A1c, Colorectal Cancer, Diabetic Retinopathy, Mammography, KED and Blood Pressure).

HOUR

Devoted Health Inc

Clinical Associate - Medical Assistant

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OTHER

Educational/Experience Requirements : Minimum of Master's Degree, Nursing with focus on Family Nurse Practitioner, Acute Care Nurse Practitioner, Adult Nurse Practitioner, Geriatric Nurse Practitioner or Adult-Geriatric Nurse Practitioner from an accredited, Nurse Practitioner program (required). The Urgent Care Advanced Practice Provider (APP) is responsible for modeling the WellBe values and mission and will play a vital role in delivering white-glove, high-quality urgent care services to patients who need your help in the comfort of their own home.

YEAR

Wellbe Senior Medical

CareConnect In Home Care APP - Rochester, New York

[AW]-iCims

Educational/Experience Requirements: Minimum of Master''s Degree, Nursing with focus on Family Nurse Practitioner, Acute Care Nurse Practitioner, Adult Nurse Practitioner, Geriatric Nurse Practitioner or Adult-Geriatric Nurse Practitioner from an accredited, Nurse Practitioner program (required). The Urgent Care Advanced Practice Provider (APP) is responsible for modeling the WellBe values and mission and will play a vital role in delivering white-glove, high-quality urgent care services to patients who need your help in the comfort of their own home.

WellBe Senior Medical

CareConnect In Home Care APP Rochester, New York

Works closely with cross-functional teams, including medical directors, nurses, care managers, Provider Network Management, Claims, Compliance, Quality, and administrative staff, to ensure efficient and effective utilization of healthcare resources. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.

VNS Health

Vice President, Clinical Assessments and Utilization Management

FULL_TIME

In partnership with clinical and administrative leadership, the Director supports consistent, compliant, and patient-centered care delivery across all sites in alignment with FQHC requirements and organizational goals. Ensure nursing and medical assistant staff effectively support the clinics’ providers and other clinical team members in delivering high-quality, coordinated, and patient-centered care.

Advantage Care Health Centers

Director of Nursing

Works closely with cross-functional teams, including medical directors, nurses, care managers, Provider Network Management, Claims, Compliance, Quality, and administrative staff, to ensure efficient and effective utilization of healthcare resources. Excellent analytical and problem-solving skills, with demonstrated ability to identify process gaps, determine root causes, develop practical solutions, and drive measurable improvement required.

Vice President, Utilization Management

Conduct high-volume telephonic outreach to providers, members, and pharmacies to close gaps in care, resolve adherence barriers (e.g., refill timing, 90-day supply conversion, mail order, cost), and coordinate therapy changes. Educate providers and office staff on clinical guidelines, measure specifications, appropriate documentation and coding, and lab ordering practices that support gap closure; influence prescribing and care decisions and respectfully push back when clinically warranted.

HealthCare Partners, MSO

Quality Interventions Pharmacist

The Applicant Manager

This role helps ensure programs are executed effectively and efficiently; stakeholders remain informed, and both clients and members receive timely, high-quality support involving clinical programs involving clinical vendor partners. The Clinical Programs Specialist provides operational and administrative support for the day-to-day management of clinical programs and clinical vendor partnerships under the direction of the Clinical Programs Specialists Manager.

Capital Rx, Inc.

Clinical Programs Specialist

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Capital Rx LLC

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798. Completes on-site provider visits to implement work plans and conduct provider education sessions regarding appropriate coding practices and chart documentation.

Healthfirst

Clinical Quality Manager

Completes on-site provider visits to implement work plans and conduct provider education sessions regarding appropriate coding practices and chart documentation. As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

HF Management Services

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Under the supervision of the Senior Director of Integrated Case Management (ICM), the Director of ICM (Medicare) provides clinical and administrative oversight for the Medicare Advantage and Integrated Benefits for Dually Eligible ("IB-Dual") populations, also known as the Medicare dual eligible special needs plan (D-SNP) line of business. Provides clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department, and collaborates with Quality Management on HEDIS, STAR ratings and CAHPS score improvement initiatives and strategies.

Metroplus Health Plan Inc

Director of Integrated Care Management (Medicare)

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. Licensure and/or Certification Required: A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED) is required.

MetroPlus Case Manager I

Collaborate with stakeholders to develop, implement, and maintain clinical programs across all lines of business, including but not limited to drug utilization review, opioid management, adherence, pharmacogenomics, disease management, and other clinical initiatives. The clinical programs manager collaborates with both internal and external stakeholders to develop and maintain clinical programs, such as analytics, product, finance, marketing, client services, sales, operations, and vendors.

Clinical Programs Manager

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.).

HarmonyCares.

Physician Leader Primary Care

Responsibilities: 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.).

HarmonyCares

Physician Leader Primary Care Bronx/Westchester NY

Licensure and/or Certification Required: A valid license and current registration to practice as a Licensed Mental Health Counselor (LMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW) issued by the New York State Education Department (NYSED) is required. Educate providers to alternate treatment services being promoted by Health + Hospitals in lieu of Inpatient Detox Attends and prepares for bi-Weekly Interdisciplinary Care Team (ICT) meetings which will feature newly enrolled, frequently admitted, high utilizing at risk HARP members.

HARP Care Manager 100% Field Based, Licensed Social Workers

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics.

Behavioral Health Care Manager

The person needs to be familiar with many different types of software including MicrosoftOffice Windows, business websites (examples: SharePoint, Arcadia, One Health Portal, HealthPlan Finder), and proprietary software (examples: electronic medical records, EKG monitors,retinal camera, etc.) Employee must be proficient with agency PM and EHR systems beforeend of probationary period. Sea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos in Washington State.

Hedis Review Nurse Jobs in New York

Clinical Associate - Medical Assistant Devoted Health Inc

CareConnect In Home Care APP - Rochester, New York Wellbe Senior Medical

CareConnect In Home Care APP Rochester, New York WellBe Senior Medical

Vice President, Clinical Assessments and Utilization Management VNS Health

Director of Nursing Advantage Care Health Centers

Vice President, Utilization Management VNS Health

Quality Interventions Pharmacist HealthCare Partners, MSO

Clinical Programs Specialist Capital Rx, Inc.

Clinical Programs Specialist Capital Rx LLC

Clinical Quality Manager Healthfirst

Clinical Quality Manager HF Management Services

Director of Integrated Care Management (Medicare) Metroplus Health Plan Inc

MetroPlus Case Manager I Metroplus Health Plan Inc

Clinical Programs Manager Capital Rx, Inc.

Physician Leader Primary Care HarmonyCares.

Physician Leader Primary Care Bronx/Westchester NY HarmonyCares

HARP Care Manager 100% Field Based, Licensed Social Workers Metroplus Health Plan Inc

Behavioral Health Care Manager Metroplus Health Plan Inc

Psychiatric Provider Aide Sea Mar Community Health Centers

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