- US Tech Solutions (May, OK)
- …to assist in any way possible to complete the screenings. * Search for relevant HEDIS records from databases, review medical records using HEDIS technical ... Participates in the member and provider outreach, collection, and review of medical records to abstract clinical information for... of medical records to abstract clinical information for HEDIS quality reporting. Training will be provided prior to… more
- Queen's Health System (Honolulu, HI)
- …of records via secured file transfer protocol (FTP) sites for quality and payor review of records ( HEDIS /Risk Adjustment/RAC). II . TYPICAL PHYSICAL DEMANDS: ... business. * Upon request, releases records electronically for admitted patient's payor concurrent review of records. * Upon request, releases electronic copies… more
- HCA Healthcare (Salt Lake City, UT)
- …+ Working knowledge of electronic medical records, medical terminology, ICD-10, CPT II coding, HEDIS measures, and medical office processes (preferred) + ... Medical Home (PCMH), government programs (CMS), accountable care organizations (ACOs), HEDIS , and experience with payor cost sharing initiatives + Excellent oral… more
- HCA Healthcare (Salt Lake City, UT)
- …+ Working knowledge of electronic medical records, medical terminology, ICD-10, CPT II coding, HEDIS measures, and medical office processes (preferred) + ... Medical Home (PCMH), government programs (CMS), accountable care organizations (ACOs), HEDIS , and experience with payor cost sharing initiatives + Excellent oral… more
- Ventura County (Ventura, CA)
- …years of full-time experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must ... the Senior Medical Management Nurse is responsible for performing utilization review , case management, and quality improvement functions to ensure that members… more
- Aspirus Ironwood Hospital (Wausau, WI)
- … (CPUR), or Diplomat of American Board of Quality Assurance and Utilization Review Physicians (D-ABQAURP) + Knowledge of HEDIS , MIPS, Core Measures, NCQA. ... Coordination is responsible for system-wide Care Coordination functions (Utilization Review , Social Work, Navigation, and Case Management) including the execution… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical ... clinical reviews with attending physicians or other providers to discuss review determinations with providers and external physicians. + Conduct clinical appeal… more