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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. 3+ years of experience in HEDIS record collection and risk adjustment (coding.
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Manage the planning, execution and evaluation of QIHEP initiatives, HEDIS and practice transformation provider projects from initiation/pilot phase through project closure to improve quality performance, SCFHP's HEDIS scores, and other quality metrics.
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Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
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Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
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We are seeking a highly motivated and detail-oriented Clinical Pharmacist with a PharmD degree and experience in HEDIS medication adherence initiatives. Minimum of 2 years of experience in HEDIS-related medication adherence work, quality improvement, or population health.
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Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. The IT Program Manager III and IPM define OKR's (Objectives, Key Results) in support of Enterprise and Portfolio strategic initiatives.
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Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards.
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The team independently maintains the HEDIS/QARR data repository that informs reporting of HEDIS, QARR, and PCMH data to NYS DOH and CMS. To that end, the team carries the responsibility of ensuring the monthly rates and annual HEDIS and QARR submissions are timely, and quality checked for accuracy and completion.
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2 years of Managed Care experience with knowledge of service coordination or case management, NCQA Accreditation, and HEDIS, in a managed healthcare environment, preferred. The SC Director ensures that all regulatory requirements are met that are appropriate to HPPs’ CHC Program, including NCQA and HEDIS requirements.
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The vendors include, but are not limited to: HEDIS software vendor, member rewards vendor, communications vendor, and provider and member portal vendor, as well as the CMS and NY state-mandated vendors for data transmission.
$131,000 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Key performance indicators used to identify success in improving the overall health of our members include meeting treatment plan goals, increased adherence to treatment plan compliance, decreased preventable medical/psychiatric events, (e.g., emergency room utilization, hospital admissions, and hospital readmissions), post hospital discharge follow up measures (HEDIS), and member retention.
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Oversee national clinical approach to integrating HEDIS & HCC-related opportunities into clinical pathways, education, and feedback loops to improve clinical effectiveness. Serve as dyad clinical partner for HEDIS/STARS, Coding, Learning & Development and Expansion leaders nationally.
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Other key responsibilities include medical record data abstraction for Healthcare Effectiveness Data and Information Set (HEDIS) and MassHealth Appendix Q review. The clinical nurse analyst will provide clinical expertise and support for departmental initiatives and the Quality Program structure as well as periodically assist in file review for NCQA accreditation.
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Act as dyad clinical partner for HEDIS/STARS, Coding, Learning & Development, and Expansion leaders nationally. Humana's Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating over 200 centers across ten states under two brands: CenterWell & Conviva.
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Dyad clinical partner for HEDIS/STARS, Coding, Learning & Development and Expansion leaders nationally. Dyad clinical partner for HEDIS/STARS, Coding, Learning & Development and Expansion leaders nationally.
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hedis job Title: support analyst
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