- Molina Healthcare (New York, NY)
- … HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. **Job Qualifications** **REQUIRED EDUCATION:** High School Diploma ... well as minimum over read standards. **Job Duties** + Coordinates the HEDIS medical record review which includes ongoing review of records submitted by… more
- Molina Healthcare (New York, NY)
- …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
- VNS Health (Manhattan, NY)
- …support critical Quality Improvement functions (eg, Performance Improvement Projects, including HEDIS , state-based measure reporting and medical record review ). ... OverviewLeads and manages all aspects of data for the HEDIS /STARS/QARR/QIP functions, which includes but are not limited to, data collection and submission, quality… more
- Molina Healthcare (New York, NY)
- …to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success. * Partner with other teams to ensure data quality ... communicate risks and issues to stakeholders and leadership. * Create, review , and approve program documentation, including plans, reports, and records. *… more
- Molina Healthcare (New York, NY)
- …communicate risks and issues to stakeholders and leadership. * Create, review , and approve program documentation, including plans, reports, and records. * ... experience in risk adjustment and/or quality * 4+ years of experience supporting HEDIS engine activity, risk adjustment targeting and reporting systems * 4+ years of… more
- VNS Health (Manhattan, NY)
- …interdepartmental quality improvement activities such as development and engagement, clinical review , clinical risk management, and patient satisfaction. Serves as a ... care providers or specialist to address non-adherence and/or clinical diagnosis for HEDIS /QARR exclusion. + Participates and leads improvement teams and projects and… more
- VNS Health (Manhattan, NY)
- …consultant for unusual and difficult medical cases. Participates in the QARR/ HEDIS Quality Improvement Activities and utilization management of the population. Works ... do + Provides oversight of VNS Health Plans clinical components for utilization review and decision making. + Leads in establishing medical policies for VNS Health… more
- Molina Healthcare (New York, NY)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services ... E** **X** **PE** **R** **I** **E** **N** **C** **E:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience with NCQA, … more
- VNS Health (Manhattan, NY)
- …between numerous provider offices across all regions to promote Quality of care, HEDIS and STARS measures and accurate ICD coding and accuracy for our members. ... engagement team by assisting with analysis, trending, and presentation of audit/ review findings, outcomes, and issues. + Utilizes resources and practices sound… more