- ProKatchers (Bowling Green, NY)
- Position: HEDIS Quality Reviewer / Clinical Quality Reviewer Duration: 03+ months contract (Possible extension) Location: Manhattan, NY 10004 Shift :: 9:00am- ... summarize and report findings. Additionally, participation in the annual HEDIS and QARR hybrid medical record review ...medical records (electronic and paper-based) Serve as a final reviewer of HEDIS and QARR records. Other… more
- Signet Health (Clinton, MD)
- …Case management members. Collaboration with Community Support Programs. Utilization Review for Designated Hospitalized members. Phone Coverage for urgent line ... members with appropriate community resources. Perform reports documenting compliance with HEDIS measures. Perform chart reviews to evaluate compliance with HEDIS… more
- Signet Health (Clinton, MD)
- …regarding Case management members Collaboration with Community Support Programs Utilization Review for Designated Hospitalized members Phone Coverage for urgent line ... members with appropriate community resources Perform reports documenting compliance with HEDIS measures Perform chart reviews to evaluate compliance with HEDIS… more
- Centers Plan for Healthy Living (Garden City, NY)
- HEDIS Reviewer 990 Stewart Ave, Garden City, NY 11530, USA Req #879 Monday, April 29, 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
- 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 ... accurate data entering of medical records and service data according to HEDIS / Somatus Technical Specifications. The primary focus of this role will be to analyze… more
- Elevance Health (Columbus, GA)
- …and insightful analytics to improve the delivery of care. **Behavioral Health HEDIS Quality Program Director** This is an Individual Contributor Role. Location: ... Hours: **Monday through Friday, 40 hrs a week.** The **Behavioral Health HEDIS Quality Program Director** is responsible for leading and implementing enterprise-wide… more
- Centene Corporation (Springfield, IL)
- …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
- Actalent (Tigard, OR)
- …group practices. Serves to collaborate with providers in the field to improve HEDIS measures and provides education for HEDIS measures and coding. Supports ... deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS . Conducts telephonic outreach while embedded in the providers' offices to… more
- Centene Corporation (Columbia, SC)
- …results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS and other measure sets in ... Lead data collection and abstraction for company quality measures, including HEDIS , CMS, CHIPRA and/or any other custom measurements. + Assess vendor-delegated… 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
- Universal Health Services (Riverside, CA)
- …and receive care. SUMMARY: This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness ... of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the… more
- CVS Health (Harrisburg, PA)
- …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
- Marshfield Clinic (Marshfield, WI)
- …National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set ( HEDIS ), and 5 Star Quality Measures. Position can be remote or in ... Assurance (NCQA) or Healthcare Effectiveness Data and Information Set ( HEDIS ) standards. **CERTIFICATIONS/LICENSES** _The following licensure(s), certification(s), registration(s), etc.,… more
- Adecco US, Inc. (Queens County, NY)
- …IPAs, and other provider groups/ supporting practice workflows, fulfillment of HEDIS and other quality measures, comfortable presenting to physician practices, ... as a collaborative care approach ideology. . Monitor, interpret, and report HEDIS and other quality performance measures, market trends, and initiatives that impact… 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
- VIP Care (Tampa, FL)
- …scheduled for appointments + Quality Program + Accessing various office EMRs to review upcoming schedule + Accessing proprietary portal to download and print forms ... visit + Ensuring the accuracy of form information + HEDIS Part C + Gap reports (ie: data mining...to appointments, referrals, etc.) + Assist with closing identified HEDIS gaps and achieving specified Star measures + Work… more
- Highmark Health (Dover, DE)
- …appropriate departments in the areas of compliance, process improvement, medical record review and coding, and member and provider satisfaction for all product ... identify gaps and communicate results. Conduct continuing education to providers on STARS, HEDIS , and HCC Coding. Conduct re-audits as needed. + Other duties as… 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
- ERP International (Camp Pendleton, CA)
- …Population Health Program, including strategic marketing for specific audiences. * Review beneficiary data from DHB and current and previous analytical data ... time and to the appropriate personnel. * Prepare, analyze, review , and present various materials to HPW Public Health...Collaborate with the Healthcare Effectiveness Data and Information Set ( HEDIS ) Clinical Quality Teams on a monthly basis to… more
- Sea Mar Community Health Centers (Vancouver, 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
