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The position is responsible for management, implementation and delivery of assigned audit phases, including planning, fieldwork, and reporting of HCC Risk Adjustment, Ambulatory Care Programs, Healthcare Effectiveness Data and Information Set (HEDIS) and other reporting.
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Responsible for partnering with MHI RQES and VP Stars in developing the local Medicare Stars work plan and executes on interventions that will improve CAHPS, HEDIS and HOS scores. Supports MHI HEDIS Operations to do majority of HEDIS abstractions.
$122,430.44 - $238,739.34 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Collaboration with IT Analyst to improve BPA's and meet MIPS reporting, care gap/HEDIS quality measure reporting requirements. 2+ years experience with MIPS, HEDIS, ACO or Payer Incentive Programs (medicare advantage) preferred.
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Understands day-to-day managed care operations, Risk Adjustment and HEDIS measures. Through our ever-evolving data analytics platform, we strive to improve overall medical spending, HEDIS, and STAR measures through a collaborative effort of education, reporting and workflow management.
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This position is part of the UMMS Population Health Service Organization Value Based Care (VBC) Quality Analyst Team. Responsible for working with management and peers on the end-to-end HEDIS measures and reporting for UMMS ambulatory provider groups for VBC and Total Cost of Care Programs (TCOC.
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Under the direction of the Supervisor, Clinical Quality Improvement, the HEDIS Improvement Nurse provides support to the Supervisor, Clinical Quality Improvement and IEHP departments on HEDIS improvement related issues, serving as a resource for internal and external customers.
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Minimum 10 years experience in quality compliance/HEDIS operations, customer service or provider service in a managed care setting with previous leadership experience to include managing people, project management, team building, and experience developing performance measures that support business objectives.
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Knowledge of national quality organizations, including National Committee of Quality Assurance (NCQA) structure and standards and Health Plan Employer Data and Information Set (HEDIS) and National Quality Forum (NQF.
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Working knowledge of lnterQual IS-SI, Milliman and Robertson Managed Care Guidelines, Erickson Life Skills (Age Competencies}, Medicare Part A and Part B, Medi-Cal, NCQA,HEDIS and other criteria as identified by the Quality/Case Management Department.
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Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment and HEDIS measures Consults with the Sr. Manager of Quality and Risk Adjustment and other stakeholders on the development of goals and standards that align with the strategic plan of SHCN. Provides expertise to develop and sustain process improvements at all levels of the organization.
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Under the general supervision of the case management Director acts as a patient advocate/case manager to hospital clients. Coordinates OOA/OON Managed Care admissions, as well as meeting criteria and the Level of Care, which is appropriate according to lnterqual and Milliman & Robertson Guidelines.
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The Director will also be responsible for engaging and supporting the CBC IPA Network to tailor New York's Health Home model for children, to comprehensively offer strategies toward the development and implementation of diverse clinical programs, including but not limited to, Pathway Home™ for Children, a children’s Project ECHO, Quality Improvement Initiatives focused on Child & Adolescent HEDIS Measures.
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Facilitates, administers Health Plan clinical operations functions- prior authorization, Part A and B services, Medication Reviews, HEDIS and STARs quality gap closure, promoting membership growth.
$127,000 - $155,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Content areas for the Director will include, but not be limited to, transitions-in-care, pharmacy and medication adherence, HEDIS / Stars, accurate risk adjustment, preferred partner relationships, and patient engagement strategy.
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Determine and utilize a regular meeting cadence with assigned practices to ensure progress on practice transformation and improvement activities, as evaluated by improvement in ECIP earnings, as well as HEDIS and STARs metrics and other contract goals and value-based activities.
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