- 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
- Elevance Health (New Hyde Park, NY)
- …+ Use tools to enable HEDIS to measure deep dives and data quality review to improve HEDIS Ratings. **Minimum Requirements:** + Requires a BS/BA degree in a ... to analyze HEDIS results. + Advanced knowledge of HEDIS specifications, medical record review process including the sample and chase creation, and data… more
- VNS Health (Manhattan, NY)
- …+ Leads the clinical audit team, ensuring compliance with Medicare STARS, HEDIS /QARR, and regulatory requirements. + Develops forms, record abstracts, reports, and ... other tools used to implement concurrent and retrospective patient/member case review , including the design, testing and evaluation of the review methodology. +… 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
- 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
- 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 ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
- VNS Health (Manhattan, NY)
- …need to improve their quality of life and avoid complications. You'll review performance metrics and patient charts, identifying opportunities to support precise ... offices across all regions to promote Quality of care, HEDIS and STARS measures and accurate ICD coding and...team by assisting with analysis, trending, and presentation of audit/ review findings, outcomes, and issues. + Utilizes resources and… 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
- Catholic Health Services (Flushing, NY)
- …new staff. Participates in staff meetings and huddles as appropriate. Participates in Hedis , GPRO, and other quality programs as needed Enters provider orders into ... the electronic record for provider review and signature Preforms AWV Patient counseling and instruction on health maintenance goals Practice Operations- In close… more