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This role will work on Cost of Care, trend management, value-based care support for STARS/HEDIS and correct coding initiatives with providers as well as strategic growth and innovation initiatives.
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Works to develop and deliver high impact interventions, supporting content development and practice transformation embedded capabilities to significantly improve provider performance that drive cost of care and improve HEDIS/Stars where applicable.
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Familiarity with Population Health Management programs / initiatives such as ACO, PCMH, CCM, TCM, RPM, HEDIS, HCC, etc., is a plus. Assist with post-submission audit support when necessary.
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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.
$79,809.6 - $101,774.4 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Demonstrated knowledge of Hedis and QARR quality measures, ICD- 10 and CPT coding for reimbursement of services , required. Manages and provides clinical services in compliance with standards of Patient -Centered Medical Home standards, meaningful use of medical record data, HEDIS and QARR quality of care measurements.
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Experience working with provider groups including practice managers, population health and quality directors on improving STARS/HEDIS or Risk Adjustment performance. How you will make an impact:Designs and develops national level interventions leveraging existing tools that will drive performance in value-based care in support of the innovation and execution of corporate clinical interventions.
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Actively manage all aspects of APP care: medical decision making, specialty consults, home health and hospice referrals and review minimum of 5% of APP charts for clinical care (emphasis on medication optimization, palliative care/advance directives) and appropriate HCC/HEDIS exclusion documentation.
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The organization exceeds the 90th percentile in most HEDIS measures, is among the top provider groups nationally in patient experience and provides care at a cost well below market competitors.
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Reliant Medical Group has a long history of commitment to value-based care and clinical excellence. Reliant Medical Group is seeking an Internal Medicine Physician to join our growing care team in Shrewsbury, Massachusetts.
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The Senior Provider Engagement Professional- Practice Transformation represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence.
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The role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools.
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HEDIS, medical record, quality improvement, member outreach, medicare, chart review, NCQA, insurance, case management, utilization management, data entry, medical terminology, health care. HEDIS,medical record,quality improvement,member outreach,medicare,chart review,NCQA.
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This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS / Star technical specifications for medical records.
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Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA, URAC and HEDIS functionalities are met or exceeded.
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The HEDIS Nurse Specialist will be a member of the Quality Department working in collaboration with the different clinical departments to close care gaps. Borinquen Medical Centers is located in Miami, FL and is seeking to hire a full time HEDIS Nurse Specialist.
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hedis job Title: decision support analyst
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