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Online Resumes with "NCQA"
Registered Nurse - 15 Years of Experience - Near 01803
Professional Summary: Able to identify and address patterns of care within varying departments - Assist in implementation of safer methods of practice. Improve patient care and/or decrease costs by developing and implementing Quality Improvement projects. Interpret statistical analyses and reformat data for the clear understanding of the intended audience. Comfortable teaching, leading or coaching groups, and individuals Ab...
Tags for this Online Resume: Medicare, Surgery, Coding, Management, Operating Room, Purchasing, Quality, Quality Assurance, Quality Management, CHF, Leader of QI Teams, Patient Safety, Boston Area, EHR, General Medical/Surgical
Quality Assurance Director - 20 Years of Experience - Near 87113
Goal: To find a challenging position utilizing my abilities developed through my experiences and education with the opportunity for professional growth based on my performance. I am a high-performing Manager with 20 years of health care experience in hospital home and medical office environments. HEDIS Reviewer an experienced Social Worker/LVN/LPN licensed in New Mexico (Compact State License) and in California with strong ...
Tags for this Online Resume: Quality/HEDIS, NCQA, Health Care Industry, STARS, Therapy, Computer Aided Software Engineering, Surgical, Advanced Cardiac Life Support, Cardiopulmonary resuscitation (CPR), Support
Physician
Summary Healthcare Executive with over 25 years of experience in both Medicaid and Commercial managed care markets. Progressive leadership roles in financial modeling, predictive analytics, development and implementation of quality initiatives and cost-reduction programs. Acumen in strategic positioning, infrastructure development and design experienced in leading an organization through State, NCQA, and Department of Insur...
Tags for this Online Resume: PEDIATRIC, Public Health, Budgeting, Call Center, Management, Medical, Medical Affairs, Operating Budget, Quality, Quality Assurance
Quality Coordinator - 3 Years of Experience - Near 64056
Desire to expand my experience with NCQA HEDIS quality measure analysis, with expansion into CAHPS and Medicare measure review and analysis.
Tags for this Online Resume: HEDIS, QUALITY MEASURES, NCQA, AUDIT, MEDICAL RECORD ABSTRACTION, TRAINING, SUPPLEMENTAL DATA SOURCE, LIAISON, Quality, Quality Assurance
Case Management Manager - 20 Years of Experience - Near 02188
Summary A dynamic and results-driven senior healthcare clinician with extensive experience in managed care environments, including the design and implementation of training programs for front-end users. Recognized for leading clinical teams to achieve measurable results in administration, physician/health maintenance organization relations, and patient care. Strengths include strategic planning positioning in anticipation o...
Tags for this Online Resume: Behavioral Health, CCA, Clinical Management, Documentation, HR, Human Resources, Management, McKesson, Procurement, Training
Medical & Health Services Manager - 18 Years of Experience - Near 89141
SKILLS SUMMARY * Provider Relations and Liaison * Trainer, Presenter, Speaker * Medicaid, Medicare Advantage, Dual Eligible * Network Management, Development, and Recruitment collaboration with Regional Teams * P4P, PPO, POS, Managed Care, Medicaid, and Medicare contracting * Ancillary, Physician/Medical Group, and Facility contract administration * Complex issue resolution * HIPAA, NCQA, and CMS Compliance and contracting ...
Tags for this Online Resume: AR, Accounts Receivable, Compliance, Corrective Actions, Field Work, Financial Services, Medicare, Managed Care, Healthcare Exchange, Medicare Advantage, Medicaid Managed Care, Project Management, Provider Contracting
Quality Assurance Director - 15 Years of Experience - Near 94585
SUMMARY OF QUALIFICATIONS: * 15 years of Operations Management experience in ambulatory, behavioral health, inpatient FQHC and Indian Health * 15 years of Management/Supervision of FTE experience (union/non-union) * 12 years of Quality (CQI)/Performance Improvement experience * 10 years of Compliance, Accreditation and Risk Management experience: (JCAHO, CMS, DHCS, Title 22, URAC, NCQA, AAAHC) * 8 years of Chronic Disease T...
Tags for this Online Resume: Compliance, Management, Medication Administration, Audit, Medical, Medical Records, Microsoft Access, Program Management, DSS, health services system, population based health administration
Quality Assurance Director - 8 Years of Experience - Near 17972
Tags for this Online Resume: Quality Assurance, Project Manager, Long Term Care, Managed Care, NCQA, CPHQ, CHCA, Medicare, Medicaid, Quality Improvement, Quality Managment, CMS, Quality Improvment Projects (QIPs), Healthcare compliance auditing, Performance Measure Validation, ICD-10-CM, CPT, HCPCS
Managing Director - 12 Years of Experience - Near 76028
Professional Summary I have 20+ years' experience working in Managed Care. The last 17 years of my career have been focused on managing Clinical Quality Management and enhancing organizational performance. I have experience managing HEDIS, NCQA accreditations and URAC accreditations.
Tags for this Online Resume: management, Networking, Complaints, Quality, Quality Assurance, Quality of Service, Utilization Management, Negotiation Skills, Project Management, Quality Management
Registered Nurse - 20 Years of Experience - Near 95670
Career Summary: Over 20 years of experience in Acute Care and Health Service programs including Utilization Review, Provider Dispute Resolution, Quality Management, Inpatient and Ambulatory Case Management, and Grievance and Appeals in a managed care environment for both Health Plan and IPA/MSO settings using evidence based nationally recognized criteria such as ACOG, NCCN, MCG, InterQual and Health Plan Medical guidelines ...
Tags for this Online Resume: Compliance, Management, Quality Management, Assessments, Medical, Medicare, registered nurse, healthcare, Managed Care, Utilization Management
Director - 20 Years of Experience - Near 92708
SUMMARY Seeking a position where I can utilize my accomplished leadership skills in nursing, management and organization to provide projected, qualitative client and business outcomes. To utilize my nursing and leadership background and extensive knowledge of Managed Care, including Commercial, Medicare, and Medicaid experience, in an environment where excellence, professionalism, and vision are valued. Talented interviewer...
Tags for this Online Resume: Management, Cms, Integrate, Medicare, Assessments, Leadership, Planning, Quality, Quality Assurance
Supervisor - 8 Years of Experience - Near 95610
SUMMARY: I work in a cooperative fashion that encourages teamwork and utilize my interpersonal skills to foster resolution of issues. I consider myself meticulous and excellent at juggling multiple tasks and working under pressure. I am an experienced manager with excellent client and project management skills. I am action-oriented and possess a strong ability to communicate effectively with all type of audiences. I welcome...
Tags for this Online Resume: Managed Care, Audit, Licensing, Billing, Documentation, Data Analysis, Data Management, Diversity, Leadership, management
