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Online Resumes with "NCQA "
Case Manager - 20 Years of Experience - Near 34698
ACCOMPLISHMENTS Quality Improvement/Care Management * Developed criteria for specifications to analyze group specific data, both demographic and claims, quantifying and stratifying to determine areas of savings opportunities and health enhancements for specific accounts. * Audited patient charts for NCQA/HEDIS and Joint Commission, helping clients to achieve respective accreditation. * Abstracted charts to boost OASIS compl...
Tags for this Online Resume: Business Development, Quality, Compliance, Credentialed, Disease Management, HEDIS, Abstractor, care management, case management, RN
Project Manager - 7 Years of Experience - Near 37203
Summary of Qualifications Project & Implementations Manager with 5+ years experience specializing in software development, Health IT, Employer Wellness, Medicare Paid Services and NCQA Certification. Professional, creative and flexible with proven analytical skills. Adept at cutting down to core problems and crafting targeted solutions for multiple markets in the Health IT and Software Development space. MS Sharepoint Dashb...
Tags for this Online Resume: Project Management, Project Manager, Documentation, Process Improvements, Requirements Definition, SDLC, Services, Software, Software Development, Compliance, software, it jobs, agile, html, sql, visual studio, Implementation Manager, MS Project, Excel, Sharepoint, TFS, SCRUM, Waterfall
Quality Coordinator - 10 Years of Experience
Ideal Companies: private medical practice, health insurance company, HEDIS/NCQA
Quality Coordinator - 20 Years of Experience - Near 30121
Summary Extensive experience in managed care and acute healthcare with emphasis on Quality Management, NCQA and JCAHO, NCQA, and CARF accreditation management, Risk Management, Medical Staff Credentialing, Peer Review, and clinical data management and analysis with demonstrated success. Many years of experience with the statewide cancer registry, hospital based registries, and the American College of Surgeons Commission on ...
Tags for this Online Resume: Audit, Data Management, Documentation, Management, Patient Care, Quality, Quality Assurance, Quality Management, Cancer, Pathway
Case Management Manager - 10 Years of Experience - Near 22003
AREAS OF EXPERTISE * Program Management * Process Improvement * Program and Policy Analysis * Electronic Medical Record (EMR) * Business Process
Tags for this Online Resume: Public Health, Services, HIV, Policies and Procedures, Program Manager, Amazon Elastic MapReduce, Benefits, Bilingual, Billing, Consulting, public health, NCQA, Medical Case Management, Electronic Medical Records
Case Management Manager - 20 Years of Experience - Near 75207
Summary of Qualifications: I have worked in Managed Care in the business arena for twenty years. My objective is to have a position with an organization which will allow me to be in a position within the Health Plan industry and be responsible for supporting associates and an institution to increase the profitability. This would allow me to integrate my extensive background in clinical nursing, training, sales/ marketing pr...
Tags for this Online Resume: Training, Infrastructure, SAN (Storage Area Network), Scheduling, Documentation, Health Care Industry, Managed Care, Management, Services, Communication Skills
Registered Nurse
CAREER SUMMARY A nationally certified experienced healthcare executive with proven success in clinical and academic operations, strong strategic business planning skills, excellent fiscal management skills, and results oriented achievement of organizational goals. Over twenty five years of progressive leadership and management experience building positive senior leadership and physician relationships. Proven leadership expe...
Tags for this Online Resume: Leadership, Nursing, Services, Evaluate, PEDIATRIC, Acute Care, Business Planning, Cardiovascular, Certificate Authority, Certified Novell Engineer
Manager/Director Provider Relations
Experience Summary * 5 years of experience in Medicaid Medicare Marketing * 17 years of Provider Relations, Network Development/Management and Contracting * 10 years Managerial Experience in Provider Relations & Business Development * Full Knowledge of CMS & NCQA Regulatory Guidelines. Completed Six Sigma Seminar. * Performed QAR and STAR data analysis & CQI projects initiatives.
Tags for this Online Resume: Complaints, Services, Management, Network Management, Networking, Referrals, Business Development, PEDIATRIC, Quality Assurance, Test
Medical Office Manager - 2 Years of Experience - Near 33313
PROFILE Dedicated, enthusiastic, results-oriented Management Professional with proven ability in project management, managing people, managing work, and managing change. Demonstrates planning / project management, business acumen, oral and written communication, forward thinking, organizational and interpersonal skills. Possess excellent problem solving techniques, a strong orientation in physician data contracting methodol...
Tags for this Online Resume: Audit, Internet, Microsoft, Microsoft Excel, Microsoft Word, NICU, PICU
Medical or Health Services Manager - 11 Years of Experience - Near 02904
Qualifications: * MPH Career Summary: * Practice Manager- Internal Medicine, Infectious Disease, Travel Medicine (2007-2017) * Grant Program Manager 2007 - 2017 "I'm service oriented and committed to excellence in achieving organizational mission/goals." Professional Overview: A strategic and task oriented leader with a progressive career of 20 + years in health care. Medical office management with practice transformation e...
Tags for this Online Resume: Chemistry, Medical, Phlebotomy, Audit, Hematology, Managed Care, Management, Microbiology, Trend Analysis, HIV
Billing/Coding Specialist - 5 Years of Experience
PROFESSIONAL SUMMARY Manager of physician revenue services, medical billing, coding, collection, and financial reporting outputs with 10 years experience in fast-paced multi-speciality Medical Practice. Good Clinical Experience as a Bachelor of Nursing. In last 10 years of tenure expertize in medical billing and coding as well as training in following areas. * Oncology with Chemotherapy Billing * Primary Care * Nephrology w...
Tags for this Online Resume: Billing, Medical, Audit, Chemotherapy, Coding, Compensation, Compliance, Financial, Health Care Industry, Health Insurance Portability And Accountability Act, healthcare
Registered Nurse - 3 Years of Experience - Near 60004
Qualifications Profile Highly organized, analytical, and multifaceted registered nurse, offering extensive experience in the healthcare industry complemented with hands-on experience in utilization management and staff supervision. Performance-focused leader, skilled at directing and overseeing a wide array of tasks and services while ensuring compliance with operational and organizational standards. Knowledgeable of Nation...
Ideal Companies: Aetna
Tags for this Online Resume: Audit, Cms, Compliance, Discharge Planning, Distribution, LPN, Management, Medicare, Planning, Policies and Procedures
