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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.

Monogram Health

Market Physician Executive (MPE) - Float

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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

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Market Physician Executive - Pennsylvania

Market Physician Executive - GA Float

Preferred qualifications: * Experience managing complex, high-acuity or medically frail populations preferred * Strong clinical judgment with ability to manage complexity independently * Team-based care collaboration and communication * Comfort with value-based care, quality metrics, and documentation accuracy * Interest in longitudinal care management and population health. The physician collaborates with advanced practice clinicians, case management, and social work to address medical and psychosocial needs, while supporting quality initiatives including HEDIS, RAF accuracy, and patient experience.

YEAR

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.

What we do

Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.

<a href="https://www.youtube.com/watch?v=5PbNyi2IDkY">https://www.youtube.com/watch?v=5PbNyi2IDkY</a> 

Caring. Connecting. Growing together. 

Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. <a href="https://careers.unitedhealthgroup.com/culture/what-we-offer/">Learn more about what we offer.</a> 

• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. <a href="https://careers.unitedhealthgroup.com/culture/">Learn more about our culture.</a> 

• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. <a href="https://careers.unitedhealthgroup.com/career-areas/">Discover all the ways you can learn, grow and develop.</a>

UnitedHealth Group

Neighborhood Physician - Primary Care (High Acuity) - Optum | Vegas, Nevada

IRecruitee

Performs annual evaluations and participates in creating MAP and developmental goals for the clinician team members as well as participates in company-led initiatives, leadership readiness, and job expansion activities of assigned clinician team members. The Clinician Team Lead is a member of the clinic leadership team who provides leadership and direction to clinic providers in collaboration with their Associate Medical Director and dyad operations partners.

Clinician Team Lead (APC) - Optum New Mexico

The Clinical Supervisor will work in conjunction with the Revenue Cycle Central Billing Office (CBO), Medical Office Coordinator (MOC), clinical staff, and the medical director to ensure all clinical programs are current with evidence-based medicine, focused on population health and Triple Aim Goals, along with providing excellent clinical care. Under the general supervision of the Director of Clinical Services, this position functions as part of the front line management team, performing a variety of clinical and administrative duties related to clinical staff management and patient care at the site location level.

Frederick Health Hospital Inc

Clinical Practice Supervisor- Infusion Center

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

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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

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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. The ambulatory pharmacist partners closely with patients, physicians, advanced practice providers, nurses, and care teams to deliver evidence-based, individualized care that promotes safety, efficacy, and cost-effectiveness.

ChenMed

Ambulatory Pharmacist

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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Working collaboratively with physicians, advanced practice providers, nurses, and other healthcare professionals, this role focuses on chronic disease state management, medication optimization, patient education, and population health initiatives. Student loan forgiveness - Government program that may allow qualifying participants to have the remainder of their student loan balance forgiven (after a set amount of time and specific qualifications have been met).

Indiana University Health Inc

Ambulatory Care Pharmacist NEW

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

UnitedHealth Group Inc.

Clinician Team Lead (Apc) - Optum New Mexico

The Value-Based Case Manager plays a critical role in advancing Tampa Family Health Centers' value-based care strategy by improving clinical outcomes, reducing total cost of care, and supporting quality performance for Accountable Care Organizations (ACO) and managed care plans. Joining TFHC means becoming part of a mission-driven organization where every team member plays a vital role in supporting exceptional patient care and improving the healthcare experience for the communities we serve.

Tampa Family Health Centers is your Patient-Centered Medical Home.
Our Mission: Provide quality, caring, and accessible health care to a culturally diverse community.
Who We Are: A federally qualified health center, Tampa Family Health Centers provides high quality, affordable health care to residents of Hillsborough County. With 17 accredited and certified medical locations, TFHC continues to deliver exceptional health care to all its patients.
Patient Focused: TFHC is your Patient-Centered Medical Home. TFHC is so much more than a walk-in clinic or regular doctor&rsquo;s office. We want to be your &ldquo;medical home,&rdquo; a one-stop shop for all of your health care needs. Whether it is the common cold or continued care of a chronic illness, we are here for you. Our team of caring doctors and staff focuses on helping you achieve your health goals quickly and easily.
Community-Focused: TFHC works with local schools, shelters, and faith-based programs to provide health care, support, education, and outreach to the Tampa community. We also serve as a referral source for services such as food, shelter, financial counseling, as well as local, state, and federal assistance programs.
Our Staff: Our team is the foundation of Tampa Family Health Centers. Our well-trained staff is among the best in their fields. If you are interested in joining the TFHC Family, please see our <a href="https://www.tampachc.com/about/careers/" target="_blank" rel="noopener noreferrer">current job openings on our Career Page</a>.

TAMPA FAMILY HEALTH CENTERS, INC.

Case Manager, Value Based

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

Responsible for overseeing, planning, and implementing new and existing health plan quality improvement activities to maintain compliance with quality program requirements and reporting and monitoring for key quality program activities, and provides support and implementation of National Committee for Quality Assurance (NCQA) accreditation surveys and federal/state quality improvement compliance activities, including compliance with Healthcare Effectiveness Data and Information Set (HEDIS) regulations. Maintains the creation and ongoing revision of policies and procedures reflective of state requirements for all quality management functions, including quality monitoring audits, credentialing and recredentialing, quality of care concerns, and peer review.

Molina Healthcare Inc

Specialist, Health Plan Quality Program Mgmt & Performance (Remote in WI)

Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market. The MPE oversees the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market.

Monogram Health Inc

Market Physician Executive (MPE)

The Risk Adjustment Coder will be responsible for coordinating/supporting Prospective, retrospective, and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract and validate medical record data. The Risk Adjustment Coder will serve as an important part of the care team to improve documentation and coding accuracy, and assist the primary care team to deliver high quality preventive care to patients. .

Suvida

Risk Adjustment Coder

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. Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.

Hedis Review Nurse Jobs in the United States

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Neighborhood Physician - Primary Care (High Acuity) - Optum | Vegas, Nevada UnitedHealth Group

Clinician Team Lead (APC) - Optum New Mexico UnitedHealth Group

Clinical Practice Supervisor- Infusion Center Frederick Health Hospital Inc

Vice President, Clinical Assessments and Utilization Management VNS Health

Vice President, Utilization Management VNS Health

Ambulatory Pharmacist ChenMed

Clinical Programs Specialist Capital Rx, Inc.

Ambulatory Care Pharmacist NEW Indiana University Health Inc

Director of Nursing Advantage Care Health Centers

Clinician Team Lead (Apc) - Optum New Mexico UnitedHealth Group Inc.

Case Manager, Value Based TAMPA FAMILY HEALTH CENTERS, INC.

Case Manager Camino Health Center

Specialist, Health Plan Quality Program Mgmt & Performance (Remote in WI) Molina Healthcare Inc

Market Physician Executive (MPE) Monogram Health Inc

Risk Adjustment Coder Suvida

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