- Somatus (Mclean, VA)
- …physical and mental well-being + Community engagement opportunities + And more! The Clinical HEDIS Coordinator I will perform the functions related to the ... be to analyze and process the information collected and review the applicable medical records and clinical ...programs. + Interface with data support, quality assurance team, HEDIS Quality Manager , and IT to collect… more
- Molina Healthcare (TX)
- …Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Mentor entry and Sr. level abstractors. + Works ... lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing...vendors for the medical record collection process. + Assists Manager and Supervisor(s) in training, utilizing the standardized training… more
- Highmark Health (Harrisburg, PA)
- …+ None **Preferred** + Pharmacy **EXPERIENCE** **Required** + 3 years of clinical pharmacy management experience including drug use review activities, ... **JOB SUMMARY** This job will be accountable for the clinical pharmacy operations area, specifically the clinical ...+ Experience with regulatory entities such as CMS, NCQA, HEDIS , DOH etc. **Preferred** + None **LICENSES or CERTIFICATIONS**… more
- Dignity Health (Phoenix, AZ)
- … teams within Arizona Care Network (ACN). ACN CPLs report to the Manager of Practice Transformation within the Clinical Performance Department, and are ... and is a Dignity Health and Abrazo Health (Tenet) physician collaboration. The Clinical Performance Liaison (CPL) is an employee of Arizona Care Network, doing… more
- Molina Healthcare (Savannah, GA)
- …requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug ... regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics with regard to patient outcomes,… more
- Apicha Community Health Center (New York, NY)
- … Manager supports the implementation of strategies to drive clinical transformation toward value-based care delivery and addressing underlying health disparities ... and social determinants of health. The role encompasses analysis and review of trends and projections of key clinical metrics, supporting new program… more
- Praxis Health (Portland, OR)
- …healthcare clinic, and we're searching for an experienced LPN or MA Care Manager to join our advanced primary care team. This is a high-impact, in-house ... role for a licensed or certified clinical professional with a strong background in care coordination...with centralized PXH/Regence teams to drive performance in: + HEDIS metric tracking + Transitional Care Management (TCM) +… more
- Community Health Systems (Naples, FL)
- …of Nursing, ASN required or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required + Experience in HEDIS , MIPS, PQRS, ACO, STARS ... **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for...programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. +… 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. ... drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society… more
- Robert Half Finance & Accounting (Shrewsbury, MA)
- Description The Revenue Cycle Manager is responsible for overseeing and optimizing the end-to-end revenue cycle processes, a Federally Qualified Health Center (FQHC) ... standards, KPIs, and SLAs related to vendor performance. * Review and escalate vendor issues that impact cash flow...* Analyze claims data and suggest/implement procedures to maximize UDS/ HEDIS and incentive revenue collections (ie, ICD-10 and CPT… more
- CVS Health (Springfield, IL)
- …products including business intelligence, analytics and predictive modeling - related to clinical outcomes, clinical quality, cost of care, in collaboration with ... + Oversees all aspects of data and system-based execution for HEDIS MRR and YRMRR projects; analyzes and communicates outcomes **Required Qualifications:**… more
- CenterWell (Jacksonville, FL)
- …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals +… more
- Sharp HealthCare (San Diego, CA)
- …process. + Participates in risk management, pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review ... all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends in grievances. Supervises the process for identifying Potential… more
- Sharp HealthCare (San Diego, CA)
- …and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its' Chief Medical Officer. ... in risk management reviews. + Assists in pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review … more
- Trinity Health (Boise, ID)
- …provides education, training, support, and collaboration with primary care clinical teams and providers to support Quality Performance Improvement initiatives ... (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at...and STAR measures. This role reports to the SAMG Manager of Quality Performance Improvement, Population Health. + This… more
- Adelante (Goodyear, AZ)
- …results in the electronic health record. Clinical Collaboration + Collaborate with the clinical team to review and act on Tasks/PTAs sent by providers. + ... conducting thorough assessments of their health needs, performing essential clinical procedures, and facilitating comprehensive care plans. Collaboration with… more
- CenterWell (Richmond, VA)
- …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals +… more
- CenterWell (Daytona Beach, FL)
- …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to ... (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals *Personally… more
- Covenant Health Inc. (Knoxville, TN)
- …the patient that will meet identified needs. + Facilitates timely documentation review with the Clinical Documentation Improvement (CDI) specialist, as necessary ... Manager to ensure the staff adheres to sound clinical practices assisting in the development of educational activities...abreast of most recent changes in quality related to HEDIS measures, CMS Conditions of Participation, MIPS and other… more
- CenterWell (Savannah, GA)
- …Assisting in resolution of inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and ... early detection. The PL is responsible for executing the clinical strategy through the management of their own patient...Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators + Good understanding of best practice… more
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