- AmeriHealth Caritas (Newtown Square, PA)
- Role Overview:; The Senior Data Analyst - HEDIS Reporting is responsible for managing, analyzing, and interpreting healthcare data to support HEDIS reporting and ... quality improvement initiatives.; This role reports to the Manager, HEDIS Analytics. The Senior Data Analyst HEDIS ...Manager, HEDIS Analytics. The Senior Data Analyst HEDIS Reporting will collaborate with cross-functional teams, such as… more
- Molina Healthcare (Cleveland, OH)
- …Quality Reporting team. Designs and develops reporting solutions to assist HEDIS Outbound, Inbound extracts, Data Ingestions, Dashboards, Reports & Extracts for ... Preferred Experience 5+ Years of experience in working with HEDIS tools such as Inovalon or ClaimSphere 5+ Years...or ClaimSphere 5+ Years of experience in working with HEDIS Domain - such as Measure analysis/reconciliation on data… more
- UnitedHealth Group (Ashland, MS)
- …in the following areas: strategic planning and analysis; understanding of HEDIS , Star ratings, accurate documentation, and coding; advanced communication skills; and ... practices Drive processes and improvement initiatives that directly impact revenue, HEDIS /STAR measures and quality metrics, coding and documentation process and… more
- ChenMed (Southfield, MI)
- …to exam rooms and ensures their comfort and well-bring prior to leaving. Acts as HEDIS champion for the PCP by providing visibility of HEDIS needs for scheduled ... patients. Reports on hospitalizations including HITS census, ENS Ping, etc. Presents patients with customer service survey during check out and escalates if needed for immediate service recovery. Participates in daily and weekly huddles to provide details on… more
- Optum (Dallas, TX)
- …patients Working knowledge of Medicare Advantage Risk plans Understanding of HEDIS measurements and delivering value-based care Compensation for this specialty ... generally ranges from $229,50 to $378,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and… more
- Molina Healthcare (Grand Rapids, MI)
- …Advanced understanding health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) Advanced understanding on ... health care financial terms (eg, PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). Advanced understanding of key managed care concepts and provider reimbursement principles… more
- Commonwealth Care Alliance (Boston, MA)
- …with organizational priorities. Track provider progress on performance metrics (eg, HEDIS , readmissions, community tenure) and follow up to support improvement ... efforts. Program and Partnership Support Partner with the Health Home and Clinical teams to support consistency and quality across BH and Health Home providers. Participate in case review meetings and rounds as needed to enhance coordination and care… more
- UnitedHealth Group (Oklahoma City, OK)
- …in the healthcare system Document timely with an added focus on closing HEDIS quality gap measures and recapturing HCCs Engage new patients enrolling in the ... program with a comprehensive geriatric focused initial assessment that includes functional eval, social and safety assessments, cognitive screening, and mental health assessments and more Triage, diagnose, and treat patients on an urgent basis in home with an… more
- Evolent (Columbus, OH)
- …Experience with value-based care, utilization management, or regulatory reporting (eg, HEDIS , NCQA, Milliman) is preferred. To ensure a secure hiring process ... we have implemented several identity verification steps, including submission of a government issued photo ID. We conduct identity verification during interviews, and final interviews may require onsite attendance. All candidates must complete a comprehensive… more
- UnitedHealth Group (Philadelphia, PA)
- …therapy gaps for key chronic disease states, formulary compliance targets, and HEDIS and NCQA measures Facilitates ongoing maintenance of client custom formulary and ... utilization management updates Identifies opportunities to increase efficiency Mentors clinical coordinators, as needed You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it… more
- UnitedHealth Group (Portland, OR)
- …patient stability is consistent with their goals of care. Participates in HEDIS measure campaigns and other quality initiatives to ensure the highest standards ... of care and to promote the improvement of care management and delivery Home Base Medical Care, a part of Optum, was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Our medical group provides… more
- Molina Healthcare (Mesa, AZ)
- …Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding Knowledge of medical economics and financial ... reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations. Excellent leadership skills, especially ability to influence others who are not in a direct reporting line including ability to think strategically,… more
- Centene Corporation (Maumee, OH)
- …states, and have a (2) combination of experience in the following areas: HEDIS , managed care, quality, process improvement/ project management (such as lean, CPHQ, ... IHI training). Additional Details: - Department: MED-Quality Improvement - Business Unit: Buckeye Community Health Plan - Schedule: Monday through Friday, 8am-5pm eastern Position Purpose: Plans, organizes, and monitors quality related projects to deliver… more
- AmeriHealth Caritas (Newtown Square, PA)
- …to Medicare, medical and quality management, authorizations, claims, SIU, statutory/regulatory, non- HEDIS , Jiva/eLTSS and population health. Be a key stakeholder at ... the table of leadership and support strategic vision and goals. The candidate will become their go-to source for data, reporting, insights, and guidance.; This team will work with business owners in preparing business requirement documents and engage in data… more
- Commonwealth Care Alliance (Boston, MA)
- …or related area Demonstrated experience interpreting and applying quality measures ( HEDIS , CAHPS, HOS) and value-based contract performance metrics Experience with ... Medicare Advantage, Medicaid; and dually eligible populations Desired Experience Experience managing or supporting pay-for-performance or value-based care programs. Experience leading provider education or training sessions. Exposure to health equity… more
- AmeriHealth Caritas (Newtown Square, PA)
- …providers, and other organizations. Inform members of required actions to meet HEDIS , EPSDT, and Plan requirements through phone calls or home visits, and ... encourage compliance. Help address barriers to care and foster relationships between members and their medical/dental providers. Complete additional task-based assignments as directed by leadership. Education & Qualifications: Associate's degree in healthcare,… more
- UnitedHealth Group (Shelby, NC)
- …in ongoing meetings pertaining to patient care and clinical excellence Implements HEDIS measure campaigns and other quality initiatives to ensure the highest ... standards of care and to promote the improvement of care management and delivery On-call for caseload during business hours. Participation in clinical after hours on-call program on rotational basis Keeps current on relevant medical and nursing research,… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …In-depth understanding of complex claims procedures and medical terminology Knowledge of HEDIS , DOC, HCFA, and NCQA requirements Ability to act as a resource ... and trainer for claims processors Diversity Statement At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and… more
- UnitedHealth Group (Smithfield, NC)
- …in the healthcare system Document timely with an added focus on closing HEDIS quality gap measures and recapturing HCCs Engage new patients enrolling in the ... program with a comprehensive geriatric focused initial assessment that includes functional eval, social and safety assessments, cognitive screening, and mental health assessments and more Triage, diagnose, and treat patients on an urgent basis in home with an… more
- CenterWell Senior Primary Care (Fort Worth, TX)
- …environment. Knowledge of Medicare guidelines and coverage. Knowledge of HEDIS quality indicators. Additional Information: Guaranteed base salary + bi-annual ... bonus Excellent benefit package ? health insurance effective on your first day of employment CME Allowance/Time Occurrence Based Malpractice Insurance Relocation and sign-on bonus options 401(k) with Employer Match Life Insurance/Disability Paid Time… more
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