Quality Assurance Jobs - Page 52

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Quality Improvement Coordinator II

Sunshine State Health Plan - Sunrise, FL

Position Purpose: Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. Perform quality on site reviews of delegated entities, physician office/clinics, reso...

Quality Improvement Coordinator II

Sunshine State Health Plan - Sunrise, FL

Position Purpose: Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. Perform quality on site reviews of delegated entities, physician office/clinics, res...

Manager, Quality Improvement

Absolute Total Care - North Charleston, SC

Position Purpose: Oversee and manage the functions of the quality improvement program. Providing support to staff and communicate with departments and staff to facilitate daily quality improvement (QI) functions. Review and analyze reports, records and directives. Confer with staff to obtain data such as new projects, status of work in progress, and problems encoun...

Quality Improvement Coordinator I

California Health & Wellness - Sacramento, CA

Position Purpose: Analyze, develop, implement and monitor clinical QI initiatives to achieve healthy outcomes. Perform duties and functions to comply with quality improvement programs according to state requirements. Support Quality Assurance Performance Improvement work plan/initiatives. Schedule and assist with committee and sub-committee preparation...

HEDIS Coordinator(Columbus)

Buckeye Community Health Plan - Columbus, OH

Position Purpose: Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities. Assist with quality improvement initiatives in the service and clinical areas. Coordinate, complete, and update management on clinical quality metrics and HEDIS processes and results Establish and maintain an action plan to ...

Quality Improvement Coordinator II

Superior Health Plan - Austin, TX

Position Purpose: Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. Perform quality on site reviews of delegated entities, physician office/clinics, reso...

Clinical Compliance Auditor

Magnolia Health Plan - Jackson, MS

Position Purpose: Responsible for the auditing of corporate, health plan, and specialty company staff related to clinical systems entry and/or processes Develop and maintain the audit process and tools related to: authorizations, appeals, quality events, and case management in CCMS; interrater reliability related to InterQual; and data entry into the credentialing subsystem

Manager, Quality Improvement

California Health & Wellness - Sacramento, CA

Position Purpose: Oversee and manage the functions of the quality improvement program. Providing support to staff and communicate with departments and staff to facilitate daily quality improvement (QI) functions. Review and analyze reports, records and directives. Confer with staff to obtain data such as new projects, status of work in progress, and problems encoun...

Operations Auditor

Absolute Total Care - Columbia, SC

Position Purpose: Responsible for the auditing of systems entry, performance metrics and work processes for assigned function Compile audit findings and report to management, making recommendations for modifications and improvements to operations, systems and procedures Ensure defined goals are implemented and relevant analytics are available to measure goal perform...

Manager, Quality Improvement

Sunshine State Health Plan - Sunrise, FL

Position Purpose: Oversee and manage the functions of the quality improvement program. Providing support to staff and communicate with departments and staff to facilitate daily quality improvement (QI) functions. Review and analyze reports, records and directives. Confer with staff to obtain data such as new projects, status of work in progress, and problems enco...

Manager, Provider Network Performance

Network Development - Clayton, MO

Position Purpose: Manage and support provider network performance improvements, including analytics, reporting, training and education. Leverage various tools and solutions to support effective provider engagement activities. Collaborate with health plan leaders and providers to review network performance, including quality, cost, care gaps, and risk adjustment gaps, and develop...

Quality Improvement Specialist I

Granite State Health Plan - Bedford, NH

Position Purpose: Support the data management and quality improvement initiatives for assigned functional areas Assist with the development and coordination of all core health services data reports Support the development of quality improvement performance audit function processes and tools Assist in designing, running, managing, and data review proces...

Quality Improvement Specialist II

Peach State Health Plan - Smyrna, GA

Position Purpose: Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management. Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality Assist in data collection, data entry and generation o...

QC Assurance Analyst

AstraZeneca - Chennai, India

Function overview The Quality & Compliance group in the ‘Infrastructure and Operations' function is responsible for establishing global IT Compliance and Risk Strategy, relevant policies, standards and ‘risk appetite' in alignment with corporate risk direction Delivery/execution teams are distributed across IT/Business functions. Deployed resou...

Quality Improvement Coordinator I

Superior Health Plan - Austin, TX

Position Purpose: Analyze, develop, implement and monitor clinical QI initiatives to achieve healthy outcomes. Perform duties and functions to comply with quality improvement programs according to state requirements. Support Quality Assurance Performance Improvement work plan/initiatives. Schedule and assist with committee and sub-committee preparat...