UNKNOWN

FEED

By month 12 : Established a revenue cycle insights practice that shapes product roadmap, policy, and renewals; measurable reduction in denial rates and improved clean-claim/risk-adjustment accuracy for clients; hired and developed initial team members; become the named clinical RCM credibility voice for customers and partners. By month 6 : Documented, repeatable clinical RCM quality program covering all agents with monthly coding-accuracy and denial reporting; closed key compliance evidence requirements in partnership with Compliance and the CMO; delivered first quarterly Revenue Cycle & Clinical Insights review to key health plan/health system clients.

Penguin Ai

Principal Clinician - Revenue Cycle Management (RCM)

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Work with resources onsite at Eastman for continuation of patient education/disease management and will make appropriate referrals to Cigna Case Management as needed; and will provide Manager or Clinical Care Coordinator Team Lead a weekly list of patients who are outreached for reporting to Cigna Eastman insurance. General Summary: The Clinical Care Coordinator will outreach to any patient with a recent hospital admission/discharge, addressing the patient needs and working with the patient to minimize risk of readmission.

HOUR

Holston Medical Group

Clinical Care Coordinator

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Serving as a trusted expert and key partner to local and national executive boards, this leader establishes overarching governance frameworks, drives evidence-based practice changes, and ensures organizational accountability. The Senior Director, Clinical Quality Governance & Regulatory provides high-level strategic oversight for clinical quality, patient safety, risk management, credentialing, peer review, and regulatory compliance across both health plan and care delivery operations.

Fox Point Recruitment

Sr. Director, Clinical Quality Governance & Regulatory

Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state.

Sanford Health

Clinical Quality Specialist - Canton Medical Center - Full Time

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Conduct, collect and analyze information and data from office site and/or medical record reviews to continually improve the care, services, proper documentation and coding for members, to properly assign ICD10-CM codes to chronic conditions, and coordination with the revenue programs, credentialing and quality improvement programs to improve STARS, value-based care and achieve and maintain accreditation. May coordinate credentialing, re-credentialing, member complaint investigations, Medical Director site visit requests, facility site visit requests, activities to include other reviews, audits, accreditation activities as requested on behalf of the organization.

Highmark provides millions of people with the security of quality health insurance
Our history of helping families and companies with their health insurance needs dates to the 1930s, when our predecessor companies were established to help Pennsylvania's residents pay for health care.
Highmark was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association — Pennsylvania Blue Shield (now Highmark Blue Shield) and Blue Cross of Western Pennsylvania (now Highmark Blue Cross Blue Shield). We are now one of the largest health insurers in the United States.
Highmark's officers and board of directors set the company's strategic direction and corporate policies. They are guided by our mission, vision and values.

Highmark Inc

Clinical Quality Management Analyst

Operating under a collaborative practice agreement, this role focuses on reducing polypharmacy, enhancing medication adherence, and managing chronic diseases to improve patient outcomes and elevate quality performance metrics such as CMS Star Ratings and HEDIS scores. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: Medication Management & Optimization: Collaborates with healthcare providers to adjust medication therapies, interpret lab results, and support clinical decision-making within a protocol-driven framework.

YEAR

ChenMed LLC

Ambulatory Pharmacist

The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted Health Inc

Routine Primary Care APP (NP/PA)- Telehealth

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).

Clinical Associate - Palliative Care

OTHER

0104 . a MH/SU license (including associate-level), or are certified by the NC Substance Abuse Board or, a RN AND have four years of full-time experience working with the MH/SU/IDD population or, a master’s degree in a human service field AND at least one year of full-time experience working with the MH/SU/IDD population or, a bachelor’s degree in a human service field AND at least two years of full-time experience working with the MH/SU/IDD population or, a bachelor’s degree in a non-human service field AND at least four years of full-time experience working with the MH/SU/IDD population. Responsible to the following when based in a clinic: Facilitate on-site clinic operations including but not limited to maintaining office clinic schedule, complete clinic reminder calls, taking and documenting client vitals, completing clinic chart documentation, and integrated care services for all clinic clients, especially integrated care clients only in med management program.

HEALTH CONNECT AMERICA, INC

Integrated Care Coordinator

[AW]-iCims

Clinical Associate - Medical Assistant

The Physician Assistant role is a key member of the team that will be accountable for the care of their patient panel, maintaining accurate, timely and current patient records, and will as part of our longitudinal model will support assuring patients are followed regularly with initial, urgent, transition of care and follow up appointments as needed to care for their health needs. Job Requirements: Educational/ Experience Requirements : Minimum Master’s Degree in Physician Assistant Studies (ARC-PA) from an accredited PA education program that meets the West Virginia state requirement of Accreditation Review Commission on Education for the Physician Assistant or its successor or, prior to 2001, by the Committee on Allied Health Education and Accreditation or the Commission on Accreditation of Allied Health Education Programs.

Wellbe Senior Medical

Physician Assistant - WV Only - Parkersburg, WV - $20K Sign-on Bonus

Physician Assistant - Teays Valley, WV

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Provide clinical guidance and direction to Market teams to drive Population Health Management activities, including identifying and intervening on High-Risk Patients, formulating strategies to reduce admissions/readmissions, complete quality post hospital discharge visits, and improving the quality of visits.

Mississippi, USA

Market Physician Executive (MPE) - Float

FULL_TIME

The role integrates front-office access, scheduling, registration, eligibility, patient service, clinical back-office workflow, staffing, patient flow, documentation readiness, supply/equipment readiness, compliance execution, and revenue-cycle handoffs into one coordinated management function. · Monthly: KPI scorecard, compliance/audit readiness review, staff performance trends, patient experience, revenue-integrity trends, quality/UDS workflow performance, and written leadership report with risks and actions.

Bee Busy Wellness Center

Practice Manager

Atlanta

Market Physician Executive (MPE)

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.

DAP Health Inc

Advanced Practice Provider

Lead on-site clinical training for every new practice launch in Florida, including staff onboarding, competency validation, clinical workflow walkthroughs, and go-live support, so each practice opens ready to deliver safe, consistent care from day one. Lead annual Vaccines for Children provider re-enrollment for every practice and provider, coordinate VFC enrollment for new practices, and train staff on vaccine storage, handling, and temperature monitoring to protect site compliance and vaccine inventory.

Bluebird Kids Health

Clinical Educator

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.

Advanced Practice Provider (APP)

To participate as an active member of the triad leadership team with the admin/physician partners in the applicable ACUs providing daily assessment of nursing work, facilitating continuous improvement of health care services and transition care towards the mission/goals of University of Michigan Health, Michigan Medicine. Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally.

Hedis Review Nurse Jobs in the United States

Principal Clinician - Revenue Cycle Management (RCM) Penguin Ai

Clinical Care Coordinator Holston Medical Group

Sr. Director, Clinical Quality Governance & Regulatory Fox Point Recruitment

Clinical Quality Specialist - Canton Medical Center - Full Time Sanford Health

Clinical Quality Management Analyst Highmark Inc

Ambulatory Pharmacist ChenMed LLC

Routine Primary Care APP (NP/PA)- Telehealth Devoted Health Inc

Clinical Associate - Palliative Care Devoted Health Inc

Integrated Care Coordinator HEALTH CONNECT AMERICA, INC

Clinical Associate - Medical Assistant Devoted Health Inc

Physician Assistant - WV Only - Parkersburg, WV - $20K Sign-on Bonus Wellbe Senior Medical

Physician Assistant - Teays Valley, WV Wellbe Senior Medical

Market Physician Executive (MPE) - Float Mississippi, USA

Practice Manager Bee Busy Wellness Center

Market Physician Executive (MPE) Atlanta

Advanced Practice Provider DAP Health Inc

Clinical Educator Bluebird Kids Health

Advanced Practice Provider (APP) DAP Health Inc

NURSING SUPERVISOR Ambulatory Care Services Medical Specialties University of Michigan

Market Physician Executive (MPE) Monogram Health

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