- 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
- Molina Healthcare (Yonkers, NY)
- …present to varying stakeholder audiences._ + _3+ years regulatory/contract requirements review and analysis experience including clinical or case management program ... to population health and case management program requirements, as well as HEDIS and STARs._ **Preferred License, Certification, Association** Any of the following:… more