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Strong understanding of healthcare quality measures, including NCQA HEDIS measures, measures derived from EHR and other standardized datasets, administrative data, and public health databases. Manage the process of NCQA certification for HEDIS measures, including data collection, submission, and validation.
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Candidate Education: Required A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Supervises risk coding, HEDIS quality metric completion by group providers and provides feedback. Maintains OSHA, ACHA, emergency preparedness, infection control and regulatory compliance for the clinic.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Conduct in-state provider educational sessions in person on relevant topics such as new business tools, billing/coding, Health e-Blue (HeB), HEDIS, medical record reviews, etc. Knowledge of NCQA HEDIS measures.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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This position will be subject to, and have center oversight for, the following metrics/competencies that are regularly assessed to help our clinicians become successful and reach Partnership status: panel size, patient outcomes (admissions and hospital sick days), CG CAHPS and net promoter score (patient experience), HEDIS and clinical gaps closures, and medical cost effectiveness measures.
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HEDIS -Health Effectiveness Data and Information Sets. HRA – Health Risk Assessment (Filler / temporary) Healthcare background (doctors office, hospital setting, 2+ years) PSO – Preventative Service Outreach (Majority.
RemoteExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Technical experience with supplemental data, HEDIS medical records review strongly preferred. Experience working with claims, EMR, HIE and/or other medical management systems strongly preferred.
$56,200ExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Ensure all HEDIS (Healthcare Effectiveness Data and Information Set), HCC (Hierarchical Condition Categories) and PCMH (Patient-Centered Medical Home) measures are completed in the required time frame.
$105,000 - $125,000 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Accountable for KPI's associated with the Clinical Enterprise: Including lead and lag measures such as admission/readmission rates, total medical expenditure, MDS timeliness, HCC scoring accuracy, closing of HEDIS quality gaps, ACA completion, and activities associated with the timely decisions of prior authorization service requests.
ExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Individual will be responsible for request for records, scheduling appointments at provider offices for the retrieval, performing on-site retrieval of records at practice group locations and review and abstraction of specific medical record data related to HEDIS hybrid measures.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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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 Yesterday - UpvoteDownvoteShare Job
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Familiarity with BCBS and health care industry concepts (e.g. HEDIS, Claims, Enrollment, Care Mgmt, Disease Mgmt)(Preferred) Experience with one or more of the following: DB2, SQL, AbInitio, ETL, Cognos, Tableau, JIRA, XML, Erwin, Advantage Suite, FHIR.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
Starting at $161,914.25 - $315,732.79 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Ensure accurate documentation in the electronic health record (EHR) and electronic medical record (EMR) systems, including documentation of HEDIS and Stars quality measures. Experience with HEDIS and ICD/CPT coding.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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The nurse SME will attend training provided by Mercy Care/Aetna on required data needed to meet compliance for specific Hybrid HEDIS measures. This role will involve attending training provided by Mercy Care/Aetna to gather necessary data for compliance with specific Hybrid HEDIS measures.
ExpandApply NowActive JobUpdated 3 months ago
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