- Centene Corporation (Tallahassee, FL)
- …Purpose:** Supervise and facilitate successful interventions to meet behavioral health HEDIS and Pay for Performance measures. Partner with health plans and ... regional clinical leadership to identify and implement interventions to increase HEDIS rates in behavioral health measures. + Develop and implement innovative… more
- Molina Healthcare (AZ)
- …engagement experience in a health plan setting.** **Knowledge/Skills/Abilities** The Senior Specialist , Provider Engagement contributes to one or more of these ... quality improvement functions: * Will create actionable HEDIS data and analytic insights. * Acts as a...data and analytic insights. * Acts as a lead specialist to provide project-, program-, and / or initiative-related… more
- Centers Plan for Healthy Living (Garden City, NY)
- …collect, and secure clinical documentation from Primary Care Physician (PCP) and/or Specialist (s) as indicated by HEDIS measures. + Review assigned medical ... HEDIS Reviewer 990 Stewart Ave, Garden City, NY...plans they need for healthy living. JOB SUMMARY: The HEDIS Reviewer is responsible for supporting the overall direction,… more
- Marshfield Clinic (Marshfield, WI)
- …in the world!** **Job Title:** SHP Pharmacy Quality Assurance - Auditing Specialist (Remote, hybrid or in office) **Cost Center:** 682891381 SHP-Pharmacy **Scheduled ... **Job Description:** **JOB SUMMARY** The SHP Pharmacy Quality Assurance/Auditing Specialist monitors, performs, and manages quality assurance processes including… more
- Commonwealth Care Alliance (Farmington Hills, MI)
- **Why This Role is Important to Us:** The Specialist , Quality -- Provider Engagement -- ACO/PO monitors Quality Measures within Accountable Care Organization ... Previous quality experience Experience Desired: + 1-2 years of HEDIS quality experience (as evident by HEDIS ...of HEDIS quality experience (as evident by HEDIS audits) Knowledge, Skills & Abilities Required: + Attention… more
- Molina Healthcare (Indio, CA)
- **Molina Healthcare** is hiring for a bilingual (English/Spanish) **In-Office, Health Plan Specialist ** for our **One Stop Help Center** in **Indio, California** . ... The Health Plan Specialist will be based out of our Indio 'One...Health, Healthcare, Health Care, Managed Care, MCO, Medicaid, Medicare, HEDIS , CAPHS, equity community health adviso#r, family advocate, advocacy,… more
- The Cigna Group (Philadelphia, PA)
- Job Description: Coding Education Specialist (AHIMA or AAPC certified) - Philadelphia, PA We value our talented employees, and whenever possible strive to help one ... Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Certified Coding Specialist for Providers (CCS-P) Certified Coding Specialist for Hospitals… more
- Trinity Health (Mishawaka, IN)
- **Employment Type:** Full time **Shift:** **Description:** Title: Quality Improvement Specialist - Select Health Network Full Time **JOB SUMMARY** The Quality ... Improvement Specialist assists in the continuous quality improvement and organizational...+ Understands and stays up to date with current HEDIS measures. + Performs other duties consistent with purpose… more
- Molina Healthcare (Las Vegas, NV)
- …plan and requires experience within that space. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality Interventions / QI Compliance contributes to one or ... a strong focus on MCO Quality regulatory reporting. + Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and guidance for… more
- Molina Healthcare (Las Vegas, NV)
- …surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality Interventions / QI Compliance contributes to one or ... Quality Interventions and Quality Improvement Compliance. + Acts as a lead specialist to provide project-, program-, and / or initiative-related direction and… more
- Centene Corporation (St. Louis, MO)
- …sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Provides education for HEDIS measures, appropriate medical record ... deficiencies impacting plan compliance to meet State and Federal standards for HEDIS . + Under general guidance form Senior Quality Practice Advisors and management,… more
- Centene Corporation (Carson City, NV)
- …state of Nevada** **Position Purpose:** The Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical ... and management. + Develops targeted activities to improve Star Ratings, HEDIS , CAHPS, HOS, provider satisfaction and other identified performance measures. +… more
- Commonwealth Care Alliance (Boston, MA)
- …Under the guidance of the Manager of Health Information Management, the HIM Specialist I is responsible for following processes to ensure compliant release of ... for tracking and metrics. + Obtain documentation from outside EMRs in preparation of HEDIS review, ACA and MDS assessments. + Request and review paper records from… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Quality and Compliance Specialist will provide services for both The Nappi and Community Family Medicine Clinics. Will be responsible for oversight ... basis. Responsible for statistical reporting to ensure clinic compliance with HEDIS measures and Quality Care Incentive Programs available from multiple insurance… more
- Molina Healthcare (Milwaukee, WI)
- …must reside in_ **_Wisconsin_** _for this position._ **KNOWLEDGE/SKILLS/ABILITIES** The Specialist , Quality Interventions/ QI Compliance contributes to one or more ... (CPHQ) + Nursing License (RN may be preferred for specific roles) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested… more
- InnovaCare (Ponce, PR)
- …passion and customer focus to the business. POSITION DESCRIPTION The Quality Specialist Nurse is responsible for monitoring quality of care and services delivered ... policies and procedures. Performs medical record review in physician's offices of selected HEDIS sample. Performs follow audit to those providers with a score below… more
- The Cigna Group (St. Louis, MO)
- …like, obtaining medical records, Healthcare Effectiveness Data and Information Set ( HEDIS ) measures, Risk Management and services that impact Cigna's overall STARs ... ratings. The individual will lead and support negotiations with suppliers to secure competitive prices, improve delivery, and achieve favorable terms to Cigna. Understanding of business process, legal contracts, and financial acumen is desired. This resource… more
- Centene Corporation (Tucson, AZ)
- …HBR (Health Benefits Ratio) analyses, Health Information data Information Set ( HEDIS ) analyses, and create reports for provider Review provider performance by ... both quantitative metrics and qualitative factors + Create and communicate milestone documents, dashboards and success or improvement metrics + Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and… more
- Centene Corporation (Tempe, AZ)
- …HBR (Health Benefits Ratio) analyses, Health Information data Information Set ( HEDIS ) analyses, and create reports for provider Review provider performance by ... both quantitative metrics and qualitative factors + Create and communicate milestone documents, dashboards and success or improvement metrics + Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and… 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 ... up calls which may include primary care physician and specialist appointment scheduling + Nurse notifies PCP daily of...+ Support Chart reviews and Pulls medical records for HEDIS + Supports Health Plan with CAHPS and STARS… more