• HEDIS Reviewer II

    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
    US Tech Solutions (05/07/25)
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  • HEDIS Coordinator I & II

    Somatus (Mclean, VA)
    …and mental well-being + Community engagement opportunities + And more! The HEDIS Coordinator I 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… more
    Somatus (07/25/25)
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  • Health Information Management Clerk II

    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
    Queen's Health System (07/25/25)
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  • HEDIS Supervisor

    Somatus (Mclean, VA)
    …+ Support the HEDIS manager to conduct meetings with operations to review performance. + Collaborate across cross functional teams on initiatives to address care ... well-being + Community engagement opportunities + And more! The HEDIS Supervisor will be responsible for providing operational support...department to monitor use off codes such as CPT II , ICD-10, HCPCS, etc., are identified and submitted to… more
    Somatus (07/29/25)
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  • RN Care Coordinator II

    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
    Covenant Health Inc. (07/23/25)
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  • MA Quality Performance, Pop Health Boise Clinics…

    Trinity Health (Boise, ID)
    …Quality Performance Improvement initiatives (Gaps In Care Closure) focused on Quality measures ( HEDIS ). + This position will be primarily located at one of our ... PHMA work includes supporting system-wide quality performance goals for HEDIS and STAR measures. This role reports to the...payor lists for open gaps in care, completing chart review for documentation of gap closure, and potentially some… more
    Trinity Health (07/11/25)
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  • Case Manager, RN or Licensed Behavioral Health (SN…

    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 (06/27/25)
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  • Medical Director, Commercial Line of Business

    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
    Excellus BlueCross BlueShield (07/01/25)
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  • Licensed Practical Nurse

    MyFlorida (Santa Rosa Beach, FL)
    …for this position. + The successful candidate must be able to pass a Level II Background screening. + If you are claiming Right to First Interview, you must attach ... the end of the clinic visit. + Performs Chart Review as directed for QA/QI. + Documents lab work...Documents DAP medication pick up in HMS. + Completes HEDIS /UDS measure tool for clients prior to each visit.… more
    MyFlorida (07/29/25)
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