- Molina Healthcare (Columbus, OH)
- …HEDIS /Quality projects. **Job Duties** + Performs the lead role of the HEDIS medical record review overreader/auditor which includes ongoing review of ... the annual HEDIS medical record review as well as all other HEDIS / HEDIS like project, the Lead Overreader will act as the subject matter expert for… more
- LA Care Health Plan (Los Angeles, CA)
- …enters data on HEDIS forms (tool) and over reads medical record review performed by vendors. All received medical record information is abstracted and entered ... HEDIS Abstractor II (Temporary) Job Category: Clinical Department:...records to supervisor for clarification when needed. Overreads record review performed by Medical Record vendor for accuracy and… more
- Elevance Health (Grand Prairie, TX)
- …+ Interfaces with internal and external clients, quality committees, and departments in the review of HEDIS submissions and requirements. + Manages the overall ... HEDIS audit processes and resources required to successfully lead the team. + Evaluates, interprets and summarizes ...lead the team. + Evaluates, interprets and summarizes HEDIS audit guidelines and manages the process for … more
- Insight Global (Philadelphia, PA)
- …) Strong computer skills Ability to occasionally travel to local providers Previous HEDIS review experience or experience with Utilization Review , Quality, ... Description A client of Insight Globals is looking for HEDIS RNs or LPNs for a partially remote contract...entry of medical records assigned by a Clinical Quality Lead nurse. Miles will be reimbursed for any travel.… more
- Centene Corporation (Jefferson City, MO)
- …meet company strategic objectives. Assist in training and perform duties as the Lead Project Manager. + Support HEDIS audit deliverables and compliance ... necessary + Manage the full project life cycle, including review of various sources to assess requirements, creation of...with departmental specific projects + Previous experience as a lead in a functional area, managing cross functional teams… more
- Elevance Health (Atlanta, GA)
- **Business Information Consultant Sr ( HEDIS )** **Location:** This position will work a hybrid model (remote & office). The ideal candidate will live within 50 miles ... Health PulsePoint office locations. The **Business Information Consultant Sr ( HEDIS )** is responsible for coordinating and consolidating various impact analyses… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …up to date knowledge and understanding of technical specifications for all HEDIS measures. Leads collaborative review of mapping documentation for annual ... a Subject Matter Expert to management and other departments.** **Leads collaborative review of mapping documentation for annual HEDIS Specification update… more
- Molina Healthcare (Columbus, OH)
- …in healthcare quality data. + 3+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at ... Quality Analytics team. Designs and develops reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome.… more
- Molina Healthcare (Columbus, OH)
- …national and/or regional lead , the Medical Records Collector supports the annual HEDIS audit and other HEDIS like audits, by organizing provider outreach, ... collecting medical records and reports from provider offices, loads data into the HEDIS application. + Assists the manager/ lead and quality improvement staff… more
- Medical Mutual of Ohio (OH)
- …Adjustment Programs (RAPS) and Healthcare Effectiveness Data and Information Set ( HEDIS ) while adhering to HIPAA guidelines. . Supports chart retrieval activities ... for projects related to RAPS and HEDIS efforts. Works closely with providers and other quality...Serves as the main point of contact and project lead for large provider groups. Supports other initiatives related… more
- Insight Global (Chicago, IL)
- Job Description The Lead Data Scientist/Engineer plays a pivotal role in supporting the Medicare Clinical Stars program by providing technical expertise in data ... support to enable data-driven insights for clinical stars initiatives. The Lead Data Engineer collaborates closely with data scientists, engineers, and stakeholders… more
- Independent Health (Buffalo, NY)
- …support improvement in quality of care and health outcomes as measured by HEDIS , Medicare Star, and QARR, including parameters that reflect the organization's health ... quality performance requirements for Medicare Star, Medicaid QARR, and Commercial NCQA HEDIS and CAHPS reporting. They are accountable for planning and content… more
- Centene Corporation (Jackson, MS)
- …results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS and other measure sets in ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Lead data collection and abstraction for company quality measures, including … more
- CVS Health (Tallahassee, FL)
- …calls along with provider education initiatives that supports the development of HEDIS interventions to improve mental health wellness and outcomes. The Quality ... The Quality Behavioral Health Manager develops and ensures programs support HEDIS , regulatory, and accreditation requirements. This is a remote position. Eligible… more
- Fallon Health (Worcester, MA)
- …or Senior Care Options (Navicare). The Senior Program Manager takes the lead on documentation and reporting to internal and external entities as required ... to stakeholders on interpreting information received from EOHHS and External Review Organization and providing guidance as needed. He/she interacts with other… more
- Molina Healthcare (Columbus, OH)
- …Sr Risk & Quality Performance Manager is a tactical execution role that will lead specific projects to support Molina's Risk & Quality Solutions (RQS) team and ... communicate risks and issues to stakeholders and leadership. * Create, review , and approve program documentation, including plans, reports, and records. *… more
- Sharp HealthCare (San Diego, CA)
- …in risk management reviews. + Assists in pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review ... services, 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.… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …documentation for deliverable capabilities. Partakes and highly contributes to team review of requirements and design documentation processes. Lead Business ... customer analytic capabilities and information needs are met. Partakes in team review of requirements and design documentation processes to understand and retain… more
- CVS Health (Columbus, OH)
- …DSNP/MMP complex populations (Duals Special Needs / MMP) * Develop and lead clinical strategy and objectives for the DSNP/FIDE populations, including the development ... of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing… more
- ERP International (Nellis AFB, NV)
- …by using MTF specific Quality Improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the ... and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the appropriate level of care… more