- Molina Healthcare (New York, NY)
- …Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Works with the Manager to monitor accuracy of ... projects. **Job Duties** + Performs the lead role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed… more
- Molina Healthcare (Yonkers, NY)
- …Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Provides feedback to providers on visit notes or ... audit skills. **Job Duties** + Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed… more
- 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
- 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
- Molina Healthcare (New York, NY)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and appeals process. + Contributes to projects aimed at improving Star ratings, HEDIS , CAHPS, and other quality metrics. + Assists call center pharmacy technicians… 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