- Centers Plan for Healthy Living (Garden City, NY)
- HEDIS Reviewer 990 Stewart Ave, Garden City, NY 11530, USA Req #879 Monday, June 3, 2024 Centers Plan for Healthy Living's goal is to create the ultimate ... plans they need for healthy living. JOB SUMMARY: The HEDIS Reviewer is responsible for supporting the...supporting the overall direction, coordination and implementation of the HEDIS Medical Record Review process for Centers… more
- Molina Healthcare (Los Angeles, CA)
- … HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Assists with projects and process improvement initiatives ... time. **Job Duties** + Performs the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by… more
- Molina Healthcare (Louisville, KY)
- …* Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of ... records submitted by providers and the annual HEDIS medical record review . The Senior Abstractor will be asked to perform duties where clinical decision-making… more
- Somatus (Mclean, VA)
- …and mental well-being + Community engagement opportunities + And more! The Sr. HEDIS Coordinator will perform the functions related to the outreach, collection, and ... entering of medical records and service data according to HEDIS / Somatus Technical Specifications. The primary focus of...be to analyze and process the information collected and review the applicable medical records and clinical criteria. This… more
- Trinity Health (Columbus, OH)
- …+ Responsible for working with legal counsel to obtain required vendor contracts for HEDIS production software, medical record review and auditor. + Liaison with ... of systems. + Manages the annual Healthcare Effectiveness Data and Information Set ( HEDIS ) audit and submission. **What we're looking for** : + Education: Bachelor's… more
- CareOregon (Portland, OR)
- …or Wisconsin. Position Title: Cotiviti Applications System Administrator / HEDIS Analyst Exemption Status: Exempt Department: Information Systems Manager Title: ... and customization of application systems. + Define, run, and review reports on applications performance and event anomalies; ensure...flow Preferred: + 3+ years of Cotiviti experience + HEDIS exp to include Stars and/or HEDIS … more
- Intermountain Health (Murray, UT)
- …ongoing evaluation of the UM process. 4. Oversees the management physician reviewer services, including management of scheduling, optimizing review process, and ... **Job Description:** This position is responsible for providing physician peer review and clinical direction for SelectHealth including utilization management, case… more
- Centene Corporation (St. Louis, MO)
- …field or equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill ... field. Candidate Experience: Required: 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart… more
- Highmark Health (Parkersburg, WV)
- …utilization management, immunizations, specialty pharmacy, Medicare Stars, and Medicaid HEDIS to strategies designed to promote the Organization's value based ... substitution, medication adherence, success in pharmacy related Stars and HEDIS measures, completion of comprehensive medication reviews, adherence to...Care Management + 3 - 5 years in Utilization Review + 3 - 5 years in the Health… more
- AmeriHealth Caritas (Orlando, FL)
- **Medical Director, UM Review , Family Medicine** Location: Orlando, FL Primary Job Function: Medical Management ID**: 31409 **Job Brief** Must be able to practice in ... organizational leadership in the operational areas of care management, utilization review , appeals, quality improvement and related policy and practice initiatives… more
- The Cigna Group (Mobile, AL)
- …manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR/ CAHPS performance measures. Develop and maintain a ... and metrics for customers and communicates to provider + Review STAR summary gap report (daily) by payor +...+ Support Chart reviews and Pulls medical records for HEDIS + Supports Health Plan with CAHPS and STARS… more
- CVS Health (Chicago, IL)
- …and community groups. Promotes collaboration with internal partners. + Continuous review of value based provider performance and movement of providers along ... to obtain crucial or required information from Providers, such as HEDIS , Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information… more
- Elevance Health (Woodland Hills, CA)
- …Information Set ( HEDIS ) improvement action plans, year round medical record review , and over read processes. + Monitors and reports quality measures per state, ... of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory… more
- Elevance Health (Richmond, VA)
- …will work on Cost of Care, trend management, value-based care support for STARS/ HEDIS and correct coding initiatives with providers as well as strategic growth and ... provider performance that drive cost of care and improve HEDIS /Stars where applicable. Minimum Requirements: + Requires MD or...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… more
- Commonwealth Care Alliance (Farmington Hills, MI)
- …work with doctor's office on notification, scheduling, and logistics for completing the review . + Conduct on-site review and document all quality information ... from the files reviewed. + Review reports for audit scope. Research and analyze reports...Previous quality experience Experience Desired: + 1-2 years of HEDIS quality experience (as evident by HEDIS … more
- Humana (Columbus, OH)
- …Medicaid line of business. The Data and Reporting Lead will prepare and submit data for review and discussion to state entities as well as provide data for HEDIS ... other healthcare quality measures. The Data and Reporting Lead will create, review , stratify and identify opportunities to improve health outcomes using various data… more
- Community Based Care of Brevard, Inc. (Seminole County, FL)
- …unit, to coordinate services and to ensure a seven (7) day follow up appointment. HEDIS Care Gap Reports: Review of health and wellness reports (ie, HEDIS ... Multi-Disciplinary Team (MDT), Treatment Team and other ad hoc meeting to review behavioral health needs including access to therapeutic placements and/or higher… more
- Sea Mar Community Health Centers (Aberdeen, WA)
- …in the Care Team Huddle to ensure the collection of all relative clinic forms, quality/ HEDIS measures, lab and x-ray reports and review of the Patient Manager ... not limited to: Joint Commission, NPSG, Department of Health, HEDIS , PCMH, QI and other contractual obligations. + Demonstrates...Ability to attend up to four (4) in-person lab skills/ review days within a three-hour drive of their workplace.… more
- Universal Health Services (Riverside, CA)
- …reports, Action plans from audits (CAPs), medical record audits, coordinate annual HEDIS Data Collection, conduct relevant QI studies, and coordinate CPPI. Review ... mandatory annual medical record audits on all RMC practitioners. 4. Coordinate annual HEDIS Data Collection Project. 5. Conduct relevant QI studies for both the… more
- The Cigna Group (Birmingham, AL)
- …manage relationships with participating provider practices. Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ... knowledge- able to type 35WPM. + Knowledge of utilization review requirements and procedures. + Knowledge of current health...can be a combination of LVN/RN licensure) + Previous HEDIS and/or CMS STARs experience a plus. If you… more