- ProKatchers (Bowling Green, NY)
- Position: HEDIS Quality Reviewer / Clinical Quality Reviewer Duration: 03+ months contract (Possible extension) Location: Manhattan, NY 10004 Shift :: 9:00am- ... summarize and report findings. Additionally, participation in the annual HEDIS and QARR hybrid medical record review ...medical records (electronic and paper-based) Serve as a final reviewer of HEDIS and QARR records. Other… more
- Signet Health (Clinton, MD)
- …regarding Case management members Collaboration with Community Support Programs Utilization Review for Designated Hospitalized members Phone Coverage for urgent line ... members with appropriate community resources Perform reports documenting compliance with HEDIS measures Perform chart reviews to evaluate compliance with HEDIS… more
- Signet Health (Clinton, MD)
- …Case management members. Collaboration with Community Support Programs. Utilization Review for Designated Hospitalized members. Phone Coverage for urgent line ... members with appropriate community resources. Perform reports documenting compliance with HEDIS measures. Perform chart reviews to evaluate compliance with HEDIS… more
- Centers Plan for Healthy Living (Garden City, NY)
- HEDIS Reviewer 990 Stewart Ave, Garden City, NY 11530, USA Req #879 Monday, April 29, 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
- Elevance Health (Columbus, OH)
- …+ Use tools to enable HEDIS to measure deep dives and data quality review to improve HEDIS Ratings. **Minimum Requirements:** + Requires a BS/BA degree in a ... to analyze HEDIS results. + Advanced knowledge of HEDIS specifications, medical record review process including the sample and chase creation, and data… 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)
- …and insightful analytics to improve the delivery of care. **Behavioral Health HEDIS Quality Program Director** This is an Individual Contributor Role. Location: ... Hours: **Monday through Friday, 40 hrs a week.** The **Behavioral Health HEDIS Quality Program Director** is responsible for leading and implementing enterprise-wide… more
- Actalent (Dallas, TX)
- …activities to close HEDIS care gaps. Qualifications + 1-2 years experience performing HEDIS work + Record Review for HEDIS + Data Abstraction experience ... Actalent is currently hiring for multiple HEDIS Specialist in Texas! *Must Be Located in...facilities/agencies. + Advises and educates Provider practices in appropriate HEDIS measures and NCQA requirements. + Assesses provider performance… 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)
- …group practices. Serves to collaborate with providers in the field to improve HEDIS measures and provides education for HEDIS measures and coding. Supports ... deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS . Conducts telephonic outreach while embedded in the providers' offices to… 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
- 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 (West Des Moines, IA)
- …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
- Marshfield Clinic (Marshfield, WI)
- …National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set ( HEDIS ), and 5 Star Quality Measures. Position can be remote or in ... Assurance (NCQA) or Healthcare Effectiveness Data and Information Set ( HEDIS ) standards. **CERTIFICATIONS/LICENSES** _The following licensure(s), certification(s), registration(s), etc.,… more
- Adecco US, Inc. (Queens County, NY)
- …IPAs, and other provider groups/ supporting practice workflows, fulfillment of HEDIS and other quality measures, comfortable presenting to physician practices, ... as a collaborative care approach ideology. . Monitor, interpret, and report HEDIS and other quality performance measures, market trends, and initiatives that impact… more
- Elevance Health (Atlanta, GA)
- …will work on Cost of Care, trend management, value-based care support for STARS/ HEDIS and correct coding initiatives with providers as well as strategic growth and ... provider performance that drive cost of care and improve HEDIS /Stars where applicable. Minimum Requirements: + Requires MD or...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… 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 (Tampa, 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
- 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
