17 Results for

Hedis Review Nurse Jobs in Texas

Jobs

New!

Irving, TX2 days ago

Perform Transition of Care calls on patients transitioning from an inpatient stay to home, or emergency department encounter to identify the need for a follow-up appointment, community resource needs, scheduling follow-up appointments, reviewing discharge instructions, and medications. Develop professional working relationships with ACO and CIN network providers, practice managers, and their staff to collaboratively manage follow-up care and improve overall health and wellness.

New!

Irving, TX2 days ago

New!

Austin, Texas5 days ago

Remote

$75,295–$110,834.59 Per Year

Oversees complex HEDIS project lifecycles—including data analysis, medical record abstraction, chase logic, thorough knowledge or Performance Improvement Projects (PIPs) and is able to apply that knowledge in PIP writing development, update, and analysis of data in PIPs. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

Austin, TX30+ days ago

Remote

Full-time

The team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.

Tyler, TX20 days ago

Houston, TX12 days ago

Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs: Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women. Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Laredo, Texas8 days ago

$2,400–$10,000 Per Year

Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.

Irving, TX29 days ago

$20.38–$36.44 Per Hour

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS/Star technical specifications for medical records.

san antonio, TX30+ days ago

$25.10–$40.25 Per Hour

Accrediting bodies include, but not limited to, the Centers for Medicare and Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), National Committee for Quality Assurance (NCQA) that promotes Healthcare Effectiveness Data and Information Set (HEDIS) metrics, Utilization Review Accreditation Commission (URAC), and the Joint Commission (TJC). Will perform any or a combination of the following types of coding education and audit: Basic ancillary services, Emergency Room services, Hospital Observation, Ambulatory surgery, Inpatient Admission.

San Juan, PR28 days ago

For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position. Experience supporting quality improvement initiatives, including HEDIS measures, reduction of emergency room utilization, and overall healthcare utilization management.

Houston, TX30+ days ago

The PPM functions as both a trusted clinical partner and a skilled change management professional, delivering direct practice support—on-site and remotely—to drive improvement across key performance domains including HEDIS/Stars quality measures, HCC capture rates, Annual Wellness Visit (AWV) completion, care gap closure, and EHR workflow optimization. The ideal candidate combines deep clinical or quality improvement expertise with strong interpersonal influence skills—capable of coaching frontline staff, engaging physicians, and presenting data-driven strategies to practice leadership.

New!

Houston, TX5 days ago

$321,200–$375,650 Per Year

Ensure clinicians effectively co-manage high-risk episodes of care and patients with partnered Care Integration Team (CIT) resources and programs for transitions of care management (TCM), high-risk patient management (HRPM), and social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization. Personally deliver high-quality primary care and demonstrate a high degree of patient care ownership and clinical excellence in age-friendly senior primary care including health promotion & prevention, disease management, effective specialist & hospital co-management, and complex care management.

Dallas, TX30+ days ago

Remote

Contractor

Working knowledge of Quality metrics and risk adjustment practices across all business lines Demonstrates data analytic skills Operational knowledge and experience with PowerPoint, Excel, Visio Effective communication skills Strong leadership skills" Summary: Responsible for developing, organizing, collecting, coordinating, preparing and presenting results of quality improvement studies and projects activities to monitor, evaluate and continuously improve the quality of healthcare services provided to Client member. State Plan / Department Specific Duties and Responsibilities Performs audits of materials and medical records to demonstrate compliance with contractual obligations, identify opportunities for improvement, and to validate medical record-keeping practices for credentialing and recredentialing purposes.

Azle, TX30+ days ago

Full-time

Collaborate closely with care teams including nurse practitioners, medical assistants, case managers and specialists to insure seamless patient care. Maintain ongoing communication with patients and their families, providing education on disease prevention, medication management and health lifestyle choices.

McAllen, TX30+ days ago

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. Our value-based care model brings clinical teams closer to those we serve, fostering a deeper connection, enhancing outcomes, and creating more meaningful moments for families to share at home.

McAllen, TX30+ days ago

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. Our value-based care model brings clinical teams closer to those we serve, fostering a deeper connection, enhancing outcomes, and creating more meaningful moments for families to share at home.

McAllen, Texas30+ days ago

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. Our value-based care model brings clinical teams closer to those we serve, fostering a deeper connection, enhancing outcomes, and creating more meaningful moments for families to share at home.

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Hedis Review Nurse Jobs in Texas

Licensed Nurse Care Coordinator Senior - Population Health Christus Health

Licensed Nurse Care Coordinator Senior - Population Health Admin Christus Health

HEDIS Performance Improvement Specialist Ascension

Clinical Quality Review Team Lead TriWest Healthcare Alliance

Licensed Nurse Care Coordinator Senior - Quality Management CHRISTUS Health

QI Stars Clinical RN Harris Health System

Nurse Practitioner (Per Diem) ComplexCare Solutions

Quality Medical Assistant MA WellMed Irving Texas UnitedHealth Group Inc

Coding Educator/Auditor University Health

MMM Discharge Planner BC Forward

Practice Performance Manager (Houston, TX) Apex Health Solutions

Physician Lead Humana Inc

QI Specialist I Integrated Resources, Inc

Primary Care Physician Palm Medical Centers

Physician Leader - Value Based Geriatric Primary Care HarmonyCares

Physician Leader (MD /DO) Primary Care HarmonyCares.

Physician Leader (MD /DO) Primary Care HarmonyCares

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