- Centers Plan for Healthy Living (Garden City, NY)
- HEDIS Reviewer 990 Stewart Ave, Garden City, NY 11530, USA Req #879 Monday, April 1, 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)
- …a check, or ask you for payment as part of consideration for employment. ** HEDIS Business Information Consultant** + Job Family: RDA > Business/Health Info + Type: ... + DC, WASHINGTON + MA, WOBURN + MN, MENDOTA HEIGHTS **Description** ** HEDIS Business Information Consultant** **Location:** This position will work in a hybrid… more
- Ventura County (Ventura, CA)
- …case managing complex cases, disease managing certain population, performing utilization review , supervising HEDIS documentation, and writing required analyses ... of their licensure, providing case management, disease management, and utilization review functions, to responsibilities associated with HEDIS and NCQA-oriented… 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)
- …entry, medical terminology, health care Top Skills Details: HEDIS ,medical record,quality improvement,member outreach,medicare,chart review ,NCQA Additional Skills ... to collaborate with providers in the field to improve HEDIS measures and provides education for HEDIS ...improve HEDIS measures and provides education for HEDIS measures and coding. Supports the implementation of quality… more
- Actalent (Chattanooga, TN)
- …The Supplemental Data Collection team will be collection medical data in preparation for the HEDIS audit in 2025. -- Must have active RN license in the state of ... Tennessee or compact state * Knowledge and experience of HEDIS or supplemental data project abstraction methods preferred. *...preferred, but not required * Experience in medical record review preferred * Some travel involved * Must be… more
- Highmark Health (Dover, DE)
- …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
- Actalent (Chattanooga, TN)
- …Supplemental Data Collection team will be collection medical data in preparation for the HEDIS audit in 2025. + The contract nurse is responsible for retrieval, ... review , and abstraction of medical record data, required for multiple and complex STARS and HEDIS measures as well as entering the data into company's quality… more
- Corewell Health (Grand Rapids, MI)
- …and cost savings opportunities. + Supports clinical initiatives related to NCQA, HEDIS , CAHPS, STAR measures, and other clinical quality and programs. Adheres to ... Pharmacy Policies and Procedures. Qualifications + Required Doctorate Doctor of Pharmacy degree from an accredited College of Pharmacy + Licensed Clinical Pharmacist in state of residence required + 3+ years of pharmacist experience or managed care residency… 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
- 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
- VIP Care (Orlando, 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
- Actalent (Nashville, TN)
- …outbound calling to members, providers and pharmacies in an effort to improve HEDIS metrics. The project specialists will be responsible for calling members with ... gaps for Medication Adherence to improve HEDIS . Other types of outbound calls to members, providers,...deadlines; work under moderate/minimal supervision. o Responsible for timely review of updates to drug information and drugs lists.… 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
- 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
- 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
- MyFlorida (St. Petersburg, FL)
- …disease prevention. + Participate in quality assurance activities including meetings and peer review . + Comply with HEDIS measure, meaningful use standards and ... leadership role + Experience serving on quality and/or peer review committees + Experience with HEDIS measures...and/or peer review committees + Experience with HEDIS measures and/or UDS clinical measures Florida Department of… 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