... Quality Stars Program Coordinator will focus on the clinical operations for Medicare Star ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
52 Health Plan Health Program Coordinator Jobs Hiring Near You
... Quality Stars Program Coordinator will focus on the clinical operations for Medicare Star ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
... Quality Stars Program Coordinator will focus on the clinical operations for Medicare Star ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
... Quality Stars Program Coordinator will focus on the clinical operations for Medicare Star ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Social Worker
Wheeling, WV · On-site
These members require coordinated care and integration into multiple health and social systems ... Demonstrated knowledge of Microsoft Office programs. * Flexibility, ability to multi-task and work ...
Social Worker
Wheeling, WV · On-site
These members require coordinated care and integration into multiple health and social systems ... Demonstrated knowledge of Microsoft Office programs. * Flexibility, ability to multi-task and work ...
Claims Analyst
Wheeling, WV · On-site
Completes or routes all reviews in accordance with time parameters established by The Health Plan ... Reports patterns of incorrect billing and utilization to manager or claims coordinator. * Advises ...
Claims Analyst
Wheeling, WV · On-site
Completes or routes all reviews in accordance with time parameters established by The Health Plan ... Reports patterns of incorrect billing and utilization to manager or claims coordinator. * Advises ...
Claims Analyst
Charleston, WV · On-site
Completes or routes all reviews in accordance with time parameters established by The Health Plan ... Reports patterns of incorrect billing and utilization to manager or claims coordinator. * Advises ...
Claims Analyst
Charleston, WV · On-site
Completes or routes all reviews in accordance with time parameters established by The Health Plan ... Reports patterns of incorrect billing and utilization to manager or claims coordinator. * Advises ...
Member Advocate - Pharmacy
Wheeling, WV · On-site
$17.50 - $21.25/hr
... coordinating copay assistance for members and directing members on how to apply for low-income ... Follow all plan policies and procedures. Desired: * Degree in health-related field. * Experience ...
Member Advocate - Pharmacy
Wheeling, WV · On-site
$17.50 - $21.25/hr
... coordinating copay assistance for members and directing members on how to apply for low-income ... Follow all plan policies and procedures. Desired: * Degree in health-related field. * Experience ...
Customer Service Representative
Wheeling, WV · On-site
$16 - $21.75/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Wheeling, WV · On-site
$16 - $21.75/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
Customer Service Representative
Bethlehem, WV · On-site
$15.75 - $21.25/hr
Familiar with Coordination of Benefits Ruling. Responsibilities: * Takes an average of 40-60 calls ... The Health Plan strictly prohibits and does not tolerate discrimination against employees ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
... coordinating the delivery of cost-effective, quality-based health care services for health plan members by development and implementation of care plans that address individual needs of the member ...
Credentialing Rep
Bethlehem, WV · On-site
Experience in Microsoft Office Programs such as Word, Excel and Adobe Acrobat. Desired: * College ... Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities ...
Credentialing Rep
Bethlehem, WV · On-site
Experience in Microsoft Office Programs such as Word, Excel and Adobe Acrobat. Desired: * College ... Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities ...
Credentialing Rep
Wheeling, WV · On-site
Experience in Microsoft Office Programs such as Word, Excel and Adobe Acrobat. Desired: * College ... Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities ...
Credentialing Rep
Wheeling, WV · On-site
Experience in Microsoft Office Programs such as Word, Excel and Adobe Acrobat. Desired: * College ... Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities ...
Credentialing Rep
Bethlehem, WV · On-site
Experience in Microsoft Office Programs such as Word, Excel and Adobe Acrobat. Desired: * College ... Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities ...
Credentialing Rep
Bethlehem, WV · On-site
Experience in Microsoft Office Programs such as Word, Excel and Adobe Acrobat. Desired: * College ... Adheres to all policies and procedures of The Health Plan and other regulatory/governing entities ...
Director, Case Management
Wheeling, WV · On-site
... programs while ensuring delivery of essential services that address the total health care needs of The Health Plan members. The Director of Case Management works collaboratively with the VP of ...
Director, Case Management
Wheeling, WV · On-site
... programs while ensuring delivery of essential services that address the total health care needs of The Health Plan members. The Director of Case Management works collaboratively with the VP of ...
... Health Plan policies and procedures. Required: * Registered Nurse with at least five (5) years ... Experience with care coordination, discharge planning, clinical documentation, and utilization ...
... Health Plan policies and procedures. Required: * Registered Nurse with at least five (5) years ... Experience with care coordination, discharge planning, clinical documentation, and utilization ...
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Full-time
Re-posted yesterday
Job description
Under the leadership and direction of the Vice President Quality Improvement, the Quality Stars Program Coordinator will focus on the clinical operations for Medicare Star initiatives and other quality improvement initiatives that interface with Clinical Services, Pharmacy, Quality Improvement and the Medical Economics Departments. This position is responsible for data analysis and reporting to identify trends, gaps in care, and opportunities for improvement. Conducts outreach to members and providers to improve adherence to measures. Reviews and analyzing member and provider complaints along with survey results to improve outcomes. Interfaces with the Provider Operations and Provider Experience teams for quality provider initiatives and provider education. See job description attached.
Required:
- Bachelor's degree or equivalent healthcare industry experience (five years).
- Minimum of two years of experience related to any of the following: Managed Care, Medicare Stars, HEDIS, CAHPS, HOS.
- Has the ability to prioritize and pivot to achieve goals with minimal supervision.
- Ability to build working relationships with internal staff and external stakeholders including community and vendor partners.
Desired:
- Medicare Star Ratings experience with the ability to analyze and interpret cut point predictions.
Responsibilities:
- Works with VP, Quality Improvement and Clinical Quality Stars Program Manager to learn and apply the Medicare Part C&D Star Ratings Technical Notes.
- Communicates with the Medical Economics Department and the Clinical Quality Stars Program Manager to obtain ongoing HEDIS and Stars data collections to support SMART goals.
- Works with internal departments to identify opportunites for improvement, gap closure and facilitates the development of member and provider clinical data driven initiatives to promote optimal member outcomes and provider best practices.
- Assists with tracking systems for reporting KPIs for the evaluation of activities and the effectiveness related to program initiatives and other performance/quality improvement projects.
- Interfaces with the Provider Operations and Provider Experience teams for quality provider initaitives and provider education.
- Using the PDSA cycle, identifies barriers and opportunities for improvement related to Star ratings, NCQA, CAHPS and HOS surveys and other member experience or quality metrics.
- Assists to development training and educational material that directly impacts quality initiatives.
- Participates in quality improvement meetings and committees/subcommittees and focus groups.
Equal Opportunity Employer
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
8:00am - 5:00pm
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About Health Plan
Sourced by ZipRecruiter
Industry
Insurance services
Company size
51 - 200 Employees
Headquarters location
Wheeling, WV, US
Year founded
1979