- Pride Global (Minneapolis, MN)
- …and administration skills Experience with HEDIS software tools and working with HEDIS auditors Medical record review experience Russell Tobin / Pride Global ... courses and training content for full-time employees and contractors engaged in HEDIS operations. This individual will collaborate with subject matter experts and… more
- HEALTH CARE PARTNERS (Conway, SC)
- …that matches patient age, sex and health issues. Maintain current knowledge of all Hedis Measures and review with every patient visit. Participate in the ... including triage encounters, nurse visits, medication administration, injections, etc. and review clinical and administrative tasks assigned to her by the providers… more
- MedStar Health (Washington, DC)
- …focus on HEDIS preferred and Previous experience with prior authorization review processes preferred and Previous use or knowledge of Cerner or MedConnect ... and records meeting minutes, tracks attendance; drafts meeting minutes for review and approval by Committee Chairperson; communicates meeting-related content to… more
- Vanguard Medical Group (Verona, NJ)
- …chart prep, including care gap checks, outstanding labs/imaging, and medication review . Anticipate provider needs and prepare accordingly to minimize disruptions and ... Documentation & Quality Programs Accurately capture and document quality metrics (eg, HEDIS , Medicare Annual Wellness) and screenings in the EMR. Participate in… more
- UnitedHealth Group (Brooklyn, NY)
- …or following hospitalization. Meets with members and/or their legal representatives to review newly developed or modified care plans; involves the PCP in these ... Quality Improvement Committee meetings Continuing education/journal club programs Implements HEDIS measure campaigns and other quality initiatives as directed by… more
- MetroPlusHealth (New York, NY)
- …management of medical costs through timely prospective, concurrent, and retrospective review activities. Job Description Performs telephonic review for inpatient ... as assigned, including, but not limited to, monthly audit review and preparation, quality improvement, community health education, facility/provider relations… more
- Curant Health (Smyrna, GA)
- …a hybrid call center environment, strong knowledge of CMS Stars and HEDIS quality measures, and proficiency in pharmacology, including obtaining accurate medication ... standards. Assist with initiatives tied to CMS Stars and HEDIS measures, working closely with quality teams to track...pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department… more
- Homebase Medical (Los Angeles, CA)
- …to document patient visit/interaction accurately and timely. Knowledge of HCC coding and HEDIS gaps. Active participation in an on-call rotation is required. We seek ... all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. more
- Molina Healthcare (Long Beach, CA)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. Monitors appropriate care and services ... Administration, Public Health, Healthcare Administration, etc. PREFERRED EXPERIENCE: Peer Review , medical policy/procedure development, provider contracting experience. Experience with… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …participation. The Medical Director of Behavioral Health oversees the inpatient/concurrent review process, care integration efforts, and all levels of behavioral ... committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS , CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only… more
- Molina Healthcare (TX)
- …Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Mentor entry and Sr. level abstractors. + Works ... Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers… more
- Molina Healthcare (Cincinnati, OH)
- … HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. **Job Qualifications** **REQUIRED EDUCATION:** High School Diploma ... well as minimum over read standards. **Job Duties** + Coordinates the HEDIS medical record review which includes ongoing review of records submitted by… more
- Insight Global (Philadelphia, PA)
- …position in PA or NJ. This is a fully remote position and requires previous HEDIS review experience. This person will be responsible for Quality Check of FDC/ ... Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ . Skills and Requirements Previous HEDIS review experience Active RN License or… more
- Insight Global (Philadelphia, PA)
- …) Strong computer skills Ability to occasionally travel to local providers Previous HEDIS review experience or experience with Utilization Review , Quality, ... Job Description A client of Insight Globals is looking for HEDIS RNs or LPNs for a partially remote contract position in PA and NJ. PARTIALLY remote position as it… more
- TEKsystems (Long Beach, CA)
- Description The Clinical Quality team oversees and is responsible of HEDIS medical record review pursuit and overall HEDIS submission. The HEDIS ... Entry Level will report to the Supervisor of the HEDIS Outreach Team. In this role you will be...will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also… more
- US Tech Solutions (May, OK)
- …to assist in any way possible to complete the screenings. * Search for relevant HEDIS records from databases, review medical records using HEDIS technical ... Participates in the member and provider outreach, collection, and review of medical records to abstract clinical information for... of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to… more
- Somatus (Mclean, VA)
- …mental well-being + Community engagement opportunities + And more! The Clinical HEDIS Coordinator I will perform the functions related to the outreach, collection, ... and accurate data entering of medical records and service data according to HEDIS / Somatus Technical Specifications. The primary focus of this role will be to… more
- Commonwealth Care Alliance (Boston, MA)
- …by CCA for tracking and metrics. * Obtain documentation from outside EMRs in preparation of HEDIS review , ACA and MDS assessments. * Request and review paper ... records from external organizations if/when EMR is not accessible. * Provide and obtain release of information documentation to and from members, clinicians, partnering organizations. * Responsible for recording accurately and consistently in CCAs electronic… more
- Commonwealth Care Alliance (Boston, MA)
- …other states will not be considered at this time._** **Position Summary:** The HEDIS Network Analyst will support CCA's ability to meet and surpass critical Quality ... **Essential Duties & Responsibilities:** + **Conduct weekly tracking of Quality/ HEDIS metrics, specifically focused on Initiation and Engagement of Alcohol or… more
- NTT DATA North America (IL)
- HEDIS Reviewer - State of IL Position Summary: Participates in the collection and review of medical records to abstract clinical information for HEDIS ... the start of the assignment. This position interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and populates a data… more
