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This role drives an integrated strategy across these domains to optimize clinical quality, member outcomes, and financial performance for Medicare Advantage and Commercial populations. In addition, the Director provides the clinical oversight of Appeals and Grievances, ensuring a seamless and member-centric resolution process that directly enhances member experience and satisfaction.

YEAR

COMMUNITY HOSPITAL OF MONTEREY PENINSULA

Director of Health Plan Quality (RN) - Aspire Health

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Triage all patients for basic vital signs, chief complaints and purpose of visit and reviews charts for recent visits, chronic problems, recent and outstanding laboratory studies, and other information that would facilitate prompt and complete care. The Registered Nurse Provides general nursing care to patients in the physician's office by performing their duties to the full level of their licensure in accordance with NYS guidelines as outlined below.

HOUR

St. Catherine of Siena Medical Center

Per Diem RN

OTHER

Triage all patients for basic vital signs, chief complaints and purpose of visit and reviews charts for recent visits, chronic problems, recent and outstanding laboratory studies, and other information that would facilitate prompt and complete care. The Registered Nurse Provides general nursing care to patients in the physician’s office by performing their duties to the full level of their licensure in accordance with NYS guidelines as outlined below.

Catholic Health

[AW]-iCims

Dedicated to improving the health and well- being of patients, this position collaborates with the PCP, HBMC interdisciplinary teammates and consultants, and as needed, the health plan Medical Director and other health professionals, to develop and carry out patients' goals of care in all phases of the patient journey. Certification through the American Academy of Nurse Practitioners (AANP), American Nurses Credentialing Center (ANCC), or the National Commission on Certification of Physician Assistants (NCCPA).

Optum

Nurse Practitioner or Physician Assistant - Brooklyn

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Position Summary: The Quality Improvement Nurse provides clinical leadership to enhance patient care and safety by monitoring healthcare processes, auditing clinical data, and implementing evidence-based improvements. Work collaboratively with Director of Quality to produce documents and tools for Quality Council and quality-related meetings, including taking meeting minutes for the Quality Council.

Family Health Center of Worcester Inc

Quality Improvement Nurse

FULL_TIME

Key Tasks and Responsibilities: Provides collaborative primary care and services to a panel of members Delivers ISNP Model of Care activities, develops and implements advanced care planning and embraces/executes a treat in plan model to avoid unnecessary hospitalizations Facilitates and administers Health Plan clinical operations functionsprior authorization, Part A and B services, medication reviews, HEDIS and STARs quality gap closure, and promotes membership growth Serves as a trusted advisor to members, loved ones and nursing home staff and colleagues Delivers effective and frequent communication and coordination with members PCPs, loved ones and interdisciplinary care team members on members care needs, goals of care, treatment plans/changes Supports overall market goals/targets and balances member caseloads Promotes Longevity Health with members, loved ones and nursing facilities and other stakeholders Is able to function autonomously and is accountable for practice Establishes meaningful relationships and is able to effectively function in the nursing home environment Is member-centric and customer service oriented, establishing meaningful relationships that ensure effective and high-quality care for Longevity Health members Performs other related duties as assigned You'll actively participate in nursing facility care team meetings, maintain frequent communication with members' families and loved ones, and ensure the care team stays aligned with members' goals and needs.

LiveWell Choice, LLC

Nurse Practitioner

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Responsible for carrying a complex case management case load ownership of a case management program(s) pre- authorization reviews to provide Medically Necessary timely and quality health care services in the most cost-effective manner and pharmacy reviews per population served. Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc.

MedStar Health

RN Case Manager My Health GPS

This on-site role focuses on care gap closure, preventive care coordination, patient outreach, and collaboration with payers and clinical staff to improve patient outcomes and quality performance. Founded in 1935 by Dr. Glenn Hendren and continued on by the late Dr. Richard Bowles, Northland Family Care has been serving Liberty and the surrounding area for over 83 years; we have a deep commitment to our patients and our community.

Northland Family Care

Quality Initiatives Specialist MA or LPN

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The ideal candidate will bring proven supervisory experience in a healthcare call center or clinical operations environment, experience obtaining medication histories, strong knowledge of pharmacology, and familiarity with CMS Stars and HEDIS quality measures. We are seeking a Clinical Services Support Team Supervisor in Smyrna, GA to provide operational leadership to clinical support staff within our healthcare call center environment.

Curant Health

Clinical Nurse Support Staff Supervisor

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ADAPTED_NOW

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.

In 1999, two historic Catholic charities became one, forming CHRISTUS Health and creating a unique purpose in the modern health care market - to take better care of people. To extend the healing ministry of Jesus Christ, the mission that the Sisters of Charity Health Care system and Incarnate Word Health system shared for more than a century, is now also the mission of CHRISTUS Health. Ranked among the top 10 Catholic health systems in the United States by size, the CHRISTUS Health system includes more than 40 hospitals and facilities in seven U.S. states, Chile and six states in Mexico, with assets of more than $4.6 billion. Whether seeking care in Alexandria Louisiana, or Coahuila, Mexico, patients discover that the healing spirit is alive at CHRISTUS Health.

CHRISTUS Health

Licensed Nurse Care Coordinator Senior - Population Health

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. The process includes case identification, case opening, member assessment, education and support intervention opportunities, developing care plans, conducting member-centric interventions, measuring member outcomes during re-assessment, case closure, and case reviews.

Excellus BCBS

Case Manager, RN (Multiple Openings!)

Licensed Nurse Care Coordinator - Population Health Admin

Required: Minimum of two years? experience as an outpatient RN Care Manager managing adult patients with complex medical needs and multiple chronic conditions -or- a minimum of 5 years? experience as a Registered Nurse in an acute care and/or home care setting managing adults. Clinical expertise: Develop clinical expertise in specialty areas and/or chronic conditions and be recognized as a care management resource for population management (ie COPD, Diabetes, HF, Sepsis, ESRD, Sickle Cell Anemia, HTN, etc).

The Moses H Cone Memorial Hospital

RN Care Manager Value Based Care Institute Transitions of Care

The Nurse Practitioner will provide comprehensive outpatient primary care services to adult patients, including preventive care, evaluation and treatment of acute conditions, management of chronic diseases, medication management, patient education, and coordination of care. The ideal candidate will work collaboratively with physicians, clinical staff, and the care-management team while supporting the practice’s commitment to high-quality, patient-centered, and value-based care.

Woodlands Medical Specialists, P.A.

Nurse Practitioner - WOODLANDS MEDICAL SPECIALISTS (PRIMARY CARE)

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As an integral part of the HEDIS HOS Intervention Team within Clinical Quality and Compliance, you will coordinate and collaborate with teams and associates inside and outside of HMM, including Care Management, Member and Provider Service, and Performance Measurement and Improvement. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

BlueCross and BlueShield of Massachusetts

Nurse Health Coach

Under the supervision of their supervising or collaborating Physician the Family Nurse Practitioner/Physician Assistant will: Record the medical history and provide physical exams and follow-up care according to treatment plan and medical protocols. Although support staff will be supervised by department manager, the mobile unit medical provider will also provide support and additional training of clinical support staff.

East Valley Community Health Center

Nurse Practitioner/Physician Assistant - Mobile Unit

Other information: Previous Experience Preferred: A minimum of 1 years relevant clinical care experience required (ambulatory clinic setting, clinical patient care experience, acute care setting). The RN Care Manager will work collaboratively with various teams and resources to coordinate care for patients who are at high risk for readmission and/or have complex needs associated with managing chronic conditions.

North Oaks Health Systems

AMBULATORY CARE MANAGER RN - POPULATION HEALTH

Job Responsibilities: Provide direct outreach to members and/or providers in order to close quality gaps and maintain or exceed expected population health outcomes per HEDIS, Stars and NCQA. The role goal is to reduce medical costs and improve quality ratings through member and/or provider engagement, internal quality process improvement work, and coordination of overall clinical intervention strategies.

Hedis Review Nurse Jobs in the United States

Director of Health Plan Quality (RN) - Aspire Health COMMUNITY HOSPITAL OF MONTEREY PENINSULA

RN St. Catherine of Siena Medical Center

Per Diem RN St. Catherine of Siena Medical Center

RN Catholic Health

Nurse Practitioner or Physician Assistant - Brooklyn Optum

Per Diem RN Catholic Health

Quality Improvement Nurse Family Health Center of Worcester Inc

Nurse Practitioner LiveWell Choice, LLC

RN Case Manager My Health GPS MedStar Health

Quality Initiatives Specialist MA or LPN Northland Family Care

Clinical Nurse Support Staff Supervisor Curant Health

Licensed Nurse Care Coordinator Senior - Population Health CHRISTUS Health

Case Manager, RN (Multiple Openings!) Excellus BCBS

Licensed Nurse Care Coordinator - Population Health Admin CHRISTUS Health

RN Care Manager Value Based Care Institute Transitions of Care The Moses H Cone Memorial Hospital

Nurse Practitioner - WOODLANDS MEDICAL SPECIALISTS (PRIMARY CARE) Woodlands Medical Specialists, P.A.

Nurse Health Coach BlueCross and BlueShield of Massachusetts

Nurse Practitioner/Physician Assistant - Mobile Unit East Valley Community Health Center

AMBULATORY CARE MANAGER RN - POPULATION HEALTH North Oaks Health Systems

RN Quality Care Coordinator Network Health LLC

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