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Nurse Practitioner AGPCNP-BC (Adult & Gerontology Primary Care NP)

Philadelphia, PA map
... Conducted comprehensive H&P exams/360s on a multitude of patients across lifespan as per current standards and criteria established by various health insurance companies with pertinent HEDIS measures. Coordinated care within an interdisciplinary ... - Apr 17

Quality Improvement, Compliance, Audit, Managerial

Durham, NC map
... Oversee outbound call center to ensure that HEDIS measures are implemented and met. . Manage operational policies and procedures for compliance with state/federal laws and regulations and/or process improvements/efficiencies as needed. . Facilitate ... - Apr 15

Customer Service Manager

Durham, NC map
... Coordinate with the Health Effectiveness and Data Information Set (HEDIS) Program Manager preparing systematic measurements for NCQA accreditation; Responsible for Healthcare divisional operations report Pitt County Memorial Hospital Greenville, NC ... - Apr 13

Customer Service Medical

Decatur, GA map
... Pull Electronic Medical Records from various medical sites for HEDIS and PIA reviews. Verify Demographics of Provider and Members in the OPM system. Consolidate sites that are Unscheduled with Scheduled or Completed sites. Update information ... - Apr 08

Project Management

New York, NY map
... Wrote HEDIS report process to output ~15 millions claim detail, member, provider from large scale FACETS database. . Wrote process to correct 3 years FACETS member and provider eligibility data needed for HEDIS member, provider, and claims reports. ... - Apr 06

Customer Service

Granger, IN map
... FL April 2010 – June 2012, Clerical and Data Entry • Administrative Secretary – Coventry Health Care • Clerical Coordinator for HEDIS Project – Citrus Health Care • Data Entry Clerk for SSA – Vastec • Insurance Processor – Health Plan Services • ... - Mar 31

Project Registered Nurse

Pasco County, FL map
... Research and analyze HEDIS, NCQA, JCAHO, HIPAA, Medicare and Medicaid regulations. Develop rules and policies based on legal guidelines and regulations. Develop regulatory compliance programs based on regulations and policies. Work with government ... - Mar 30

Management Medical

Grasonville, MD map
... Medical Record Review was performed for Risk Adjustment and HEDIS clients. Collaborated closely with the other Directors of the Quality Operations to ensure all teams were in alignment. Spearheaded operational functions to boost productivity and ... - Mar 24

Sales Marketing

Miami, FL map
... Manage all communications with AHCA on behalf of communicated contracted requirements, HEDIS • requirements and NCQA credentialing. 8/2012-8/2014 Media Counselors Miami, Florida Media Director Account Executive: Baptist Health of South Florida Miami ... - Mar 21

Manager Marketing

Columbus, OH map
... Sciences Advanced Analytics Predictive Modeling Credit /Debit Risk Customer Insight Offer/Creative Testing Managed Care NCQA / HEDIS 21 years experience of providing Statistical Modeling, Advanced Analytics and Customer • Insights for companies like ... - Mar 21
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