- 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
- Queen's Health System (Honolulu, HI)
- …of records via secured file transfer protocol (FTP) sites for quality and payor review of records ( HEDIS /Risk Adjustment/RAC). II . TYPICAL PHYSICAL DEMANDS: ... business. * Upon request, releases records electronically for admitted patient's payor concurrent review of records. * Upon request, releases electronic copies… more
- HCA Healthcare (Salt Lake City, UT)
- …+ Working knowledge of electronic medical records, medical terminology, ICD-10, CPT II coding, HEDIS measures, and medical office processes (preferred) + ... Medical Home (PCMH), government programs (CMS), accountable care organizations (ACOs), HEDIS , and experience with payor cost sharing initiatives + Excellent oral… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …as HEDIS /QARR/QRS. + Documents all processes and procedures relating to current HEDIS hybrid review plan. + Develops, implements, and monitors hybrid audit ... is responsible for quality activities, including but not limited to HEDIS /QARR/QRS process, quality of care concerns, NCQA requirements, medical record reviews… more
- Covenant Health Inc. (Knoxville, TN)
- …a proud member of Covenant Health! Position Summary: The RN Care Coordinator II is responsible for integrating evidenced based clinical practice into the patient ... resource and consultant to the health care team. The RN Care Coordinator II is responsible for promoting patient care coordination and quality through the… more
- Centene Corporation (Tallahassee, FL)
- …to leadership and/or customers + Manage multiple, variable tasks and data review processes with limited supervision within targeted timelines + Support the design, ... mining, population health, and statistical modeling preferred **Quality:** Experience with HEDIS , NCQA, Medicare Star Rating System, QRS, or other quality measures… more
- Ventura County (Ventura, CA)
- …years of full-time experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must ... the Senior Medical Management Nurse is responsible for performing utilization review , case management, and quality improvement functions to ensure that members… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... + Performs other functions as assigned by management. Level II (in addition to Level I Essential Accountabilities) +...being met, such as NYS DOH, CMS, NCQA, and HEDIS , serving as internal auditor within the group. +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical ... clinical reviews with attending physicians or other providers to discuss review determinations with providers and external physicians. + Conduct clinical appeal… more
- ChenMed (Margate, FL)
- …PCPs are keeping in contact with hospitalized patients and hospitalists; facilitates review of inpatients and other high priority patients during super huddle, ... teams to deliver VIP service, standards of care and quality guidelines, HEDIS /STARS, high-risk disease detection and high-risk disease management and other evidence… more