- Optum NV (Las Vegas, NV)
- …Services, Medicare Risk Adjustment Factor (RAF) education as well as HEDIS /STARS education, and provider/group relationship building. This individual may be meeting ... of patient care quality metrics to enhance clinical outcomes (eg, HEDIS ; 5 STAR; disease-based metrics) to drive/achieve quality outcomes Supporting all… more
- Suzanne Snell Human Resources and Recruiting Solutions (Newport Beach, CA)
- About the job Registered Nurse (Bi-Lingual- Spanish) Seeking candidates for a HEDIS STARS Registered Nurse (Bi-Lingual- Spanish) position for our Healthcare client ... professional to support our Healthcare Effectiveness Data and Information Set ( HEDIS )/STAR Ratings department. This role also includes fulfilling select CMS quality… more
- UnitedHealth Group (Phoenix, AZ)
- …providers to improve STARS measure performance Provide analytical interpretation and STARS/ HEDIS performance summaries to provider groups Be the subject matter ... and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider performance Analyze… more
- UHS (Riverside, CA)
- …reports, Action plans from audits (CAPs), medical record audits, coordinate annual HEDIS Data Collection, conduct relevant QI studies, and coordinate CPPI. Review ... in accordance with CMS, CDPH, and DMHC regulations and guidelines. Assist in HEDIS Data Collection and conducts Quality studies. QUALIFICATIONS: To perform this job… more
- Autonomize Inc (Austin, TX)
- …understands both the "why" and the "how" behind care management, utilization review , quality improvement, and risk adjustment. Your work will directly influence how ... for our products and solutions (eg, validation of clinical summarization, chart review , and documentation use cases) Partner directly with customer clinical teams… 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
- Fallon Health (Worcester, MA)
- …collaboratively with Fallon Health Pharmacist, referring members in need of medication review based upon Program process o Develops and fosters relationships with ... providers and office staff and may lead care plan review with providers and care team as applicable. o...policies and processes o Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member… 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
- Family Health Centers of San Diego (San Diego, CA)
- …partners, medical and operational leadership on analytic-related projects. Develop, review , and update quality improvement dashboards, scorecards, and metrics as ... systematically archive results from analyses Working knowledge and experience with HEDIS /UDS performance measures and population health initiatives Act in a liaison… more
- Molina Healthcare (Long Beach, CA)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... Medicaid eligible members as well as Medication Adherence Programs for STAR, HEDIS and behavioral health medications. *Ensures that adequate staffing coverage is… more
- CenterWell Primary Care (Las Vegas, NV)
- …defined by Clinical Leadership. Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. Participates in potential ... environment Knowledge of Medicare guidelines and coverage Knowledge of HEDIS quality indicators Additional Information Guaranteed base salary + quarterly… more
- UnitedHealth Group (Waterbury, CT)
- …or following hospitalization Meets with patients and/or their legal representatives to review newly developed or modified care plans; involves the PCP or supervising ... in ongoing meetings pertaining to patient care and clinical excellence Implements HEDIS measure campaigns and other quality initiatives to ensure the highest… more
- Livingston Community Health (Livingston, CA)
- …*Monitor and support clinical performance and quality initiatives, including UDS, HEDIS , and value-based care targets. *Represent the assigned region at ... organizational QI, Credentialing, Peer Review , Risk, and Compliance Committees meetings. *Act as a champion for population health, culturally competent care, and… more
- UnitedHealth Group (Syracuse, 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
- Community Health Centers of the Central Coast (Santa Maria, CA)
- …Attends and participates in staff meetings and ongoing nursing review meetings. Participates in specialty committees as assigned. Demonstrates professionalism ... Demonstrates adherence to Quality Improvement processes such as Meaningful Use, HEDIS , UDS and Regulatory compliance and company productivity. Maintains and adheres… 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
