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Online Resumes with "Hedis "
Physician executive strong CM/UM experience, demonstrated ability to avoid readmission and increase claims efficiance - near 60637/430
Experienced medical professional, expert in adult and geriatric medicine, care coordination that avoids unnecessary readmission,chronic disease management (including home visits,) Medicare, it's managed care partners and dual eligible,managed care administration, medical education, and clinical practice. Committed to empowering providers and utilization/care management nurses to fully partner with payors and health systems ...
Ideal Companies: BlueCross/BlueShield, Medicare, Anthem, Cigna, United Health Care, CMS, Presence, Valence
Tags for this Online Resume: Geriatrics, Chronic disease management, Utilization/Care Management, HIPAA/Clinical Medical Ethics, HealthCare Professional Education, clinical policy development, Physician, Director, Medical Director, Physician Executive, Adult Medicine, Geriatric Medicine, Care Coordination, Population Health, Dual Eligibility Systems, Risk Management, Medical Education, Multidisciplinary Education, Clinical Ethics Training, Medical Ethics, Oral Communication, Written Communication, Social Media, MS Office, MD, FACP, AGSF, Underwriting, Claims, Non Profit, Principle
Quality Coordinator - 14 Years of Experience
An accomplished multi-lingual medical program administrator/manager/trainer and auditor whose specialty in quality control, management analysis, risk and fiscal review of health care services/programs and departments, coupled with effective communication and case management expertise, thorough knowledge of QA practices, awareness of local, State and Federal government trends for quality controls and public safety of infecti...
Tags for this Online Resume: Management, Medicare, Coding, Fraud, Home Health, Risk Management, Services, Audit
Clinical Quality Assurance - 20 Years of Experience - Near 27253
Clinical trials unit to continue research in the various departments from clinical to regulatory
Tags for this Online Resume: Data Abstraction, CCS, Research Nurse, Remote CRO, ICD 9-10 coding, telehealth nurse, HEDIS, North Carolina
Manager - 20 Years of Experience - Near 94513
SUMMARY: Highly-skilled IT professional with 25 years of experience in architecting, data modeling and implementing EDW and BI with analytical reporting solutions in mainframe, client server, desktops, web-based in Healthcare MDM, Labs and Pharmacy, BI Analytics, HL7 and EDI x 12 transactions, Insurance, Finance, Retails, Utility, HR, CRM, Telecom. wireless environments. * Managed pharmacy and MDM (pharmacy, medical, claims...
Tags for this Online Resume: Teradata, Teradata (NCR Data Warehouseing product), IBM DB2 Database, Java Programming Language, Architect, Billing, Informatica, Informatica PowerCenter, PowerCenter, Project Management
Admissions Director
QUALIFICATIONS * 20 year record in sales, training, operations, and insurance experience in market strategies, selling techniques, public speaking, recruiting, management, and training. * A proven sales leader and team player dedicated to results and customer service with clients/ referral sources. * Proven Health Care Sales and Marketing Experience in Home Health, Skilled Nursing, Acute Rehabilitation, Hospice, and Behavio...
Tags for this Online Resume: Home Health, Hospice, Managed Care, Referrals, Skilled Nursing Facility, Integrate, SOC, CHF, COPD, Medicare, Tucson,, Sales and Marketing, Behavioral health, Insurance, 5 Star, HEDIS
Medical or Health Services Manager - 8 Years of Experience - Greater Chicagoland area
CAREER SUMMARY: Experienced Healthcare professional, MBA graduate, with distinction, concentrating in Health Sector Management and Operations Management, creative problem solver and successful operations management professional with proven track record of success in hands-on leadership, organizational management, managed care oversight, quality control, and quality patient care in healthcare environment. Eager to contribute...
Tags for this Online Resume: Medicare, Policies and Procedures, Billing, Coding, Compliance, Financial, Financial Statements, Managed Care, Contracting, Quality Improvement, HEDIS, Project Management, Provider Relations, Provider Engagement
Case Manager
Qualifications: To use my skills as a Registered Nurse and Case Manager to help people understand their illness, medications and how to lead a healthy lifestyle. * Able to identify and meet deadlines. * Able to set appropriate patient goals. * Able to provide accurate documentation. * Excellent ability to multi-task and be flexible. * Team coordination and working effectively with others. * Aware of outside resources to ass...
Tags for this Online Resume: Medical, Medical/Surgical, Oncology, Orthopedics, Surgical, Service & Support, Nursing Case Management, Computer Aided Software Engineering, Discharge Planning, Documentation
Quality Coordinator - 5 Years of Experience
SUMMARY An accomplished Performance Improvement/Systems Analyst with extensive experience in the Healthcare Industry quite knowledgeable in Access Database design focused on modification of Electronic Health Record (Nextgen) creative, resourceful and flexible able to adapt to changing priorities while maintaining a positive attitude and strong work ethic. TECHNICAL MS Office 2010, Visual Basic 2008, SQL Server 2008 R2, PLM,...
Tags for this Online Resume: Management, Audit, Cms, Coding, Database, Database Maintenance, Help Desk, Medicare, Pathology, Project Management, Quality Improvement, Provider Engagement, Training, Data Analysis, QARR/HEDIS, EMR Design, Systems Analyst, Documentation, Project Liaison
Health Technologist - 18 Years of Experience - Near 02446
Summary: I have over 16+ yrs. experience in HIT leadership and 9 years in academic research. I am passionate healthcare and biotechnology program delivery. I am a certified PMP practitioner of Waterfall and Agile management methodologies, consistently promoting a standard platform for implementation, upgrade and support of clinical, operational, analytical and administrative software and hardware I have led large teams both...
Tags for this Online Resume: Billing, Project Management, Project Manager, Publishing, Scheduling, Senior Project Manager, Support, ANSI, Ansi (Am Natl Stds Inst), EDI
Physician - 15 Years of Experience - Near 00757
Tags for this Online Resume: General Practitioner, Primary Care, Managed Care, Medical, Consulting, Health Insurance Portability And Accountability Act, HEDIS, Quality Assurance, ACN license, Direct Patient Care
Software Engineer - 8 Years of Experience - Near 30144
Summary of Qualifications IT professional with experience supporting information technology infrastructures. ServiceNow, Elementool, Snagit/Camtasia, VersionOne, Slack, JIRA, SVN, SSMS 2012, and Octopus for automatic deployments. 3+ years of experience in the Health Care record review field Multiple years of HIPAA regulations expertise Multiple years of experience with HEDIS and Risk Adjustment project cycles Skilled in gra...
Tags for this Online Resume: Agile, Quality, Quality Assurance, Structured Query Language, Automation, Business Analysis, Business Analyst, Confluence, Data Management, Health Insurance
Medical or Health Services Manager
SUMMARY: A dedicated and self-motivated Project Manager, drawing upon 5+ years of industry experiences within healthcare. Specialties: Process Improvement Clinical Quality Initiatives State Medicaid and Medicare Innovation models like DSRIP, Meaningful Use, HEDIS, PCMH, CCM and Transition of Care Healthcare Information Technology, Financial Analysis Budgeting Strategic planning & Operations and Grant & Report writing
Tags for this Online Resume: Medical, Fraud, Call Center, Documentation, Financial, Financial Analysis, Insurance, Quality, Policies and Procedures, Management
