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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.
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Under general guidance form Senior Quality Practice Advisors and management, educates community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.
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Knowledge of NCQA HEDIS measures. 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.
Full-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Working knowledge of NCQA HEDIS technical specifications, medical terminology, and health plan processes preferred. 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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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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Preferred License, Certification, AssociationActive, unrestricted Certified Professional in Health Quality (CPHQ)Active, unrestricted Nursing License (RN may be preferred for specific roles)Active, unrestricted Certified HEDIS Compliance Auditor (CHCA)To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Starting at $44,936.59 - $97,362.61 a year depends on education, experienceFull-timeRemoteExpandApply NowActive JobUpdated 19 days ago - UpvoteDownvoteShare Job
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Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements. Review records for compliance with regulatory guidelines (e.g., NCQA, State, Clinical Practice Guidelines, CMS.
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QARR, NCQA, CMS, Enrollment, Acumen). Data sources may include regulatory, external, internal, and third-party data or other relevant sources (Ex. HEDIS, CAHPS, HOS, 2 or more years' experience supporting HEDIS Operations and audit submissions.
$75,870 a yearExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Awareness of NCQA requirements, CMS guidelines, Medicaid/Medicare contracts and benefit systems. Implements HEDIS measure campaigns and other quality initiatives as directed by Corporate Health Services to ensure the highest standards of care and to promote the improvement of care management and delivery.
$40,000Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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HEDIS Certified Measures® is a registered trademark of the National Committee for Quality Assurance (NCQA). Certified HEDIS Compliance Auditor (CHCA) required. At least five years of auditing experience and four years of experience as a lead auditor; at least four years in HEDIS auditing and/or data validation, with at least one year as a lead are required.
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We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. As a team member of our Landmark product, we help bring home-based medical care to complex, chronic patients.
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Manage the process of NCQA certification for HEDIS measures, including data collection, submission, and validation. You will participate in measure certification processes, such as the NCQA certification process for HEDIS measures.
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Understanding of quality measurement standards, regulations, and accreditation requirements, including NCQA, CMS, and other regulatory bodies. Familiarity with healthcare regulatory requirements, including NCQA accreditation standards and CMS quality reporting programs.
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Ensure compliance with NCQA standards and requirements for quality measurement and reporting. Bachelor's or Master's degree in Health Informatics, Statistics, Public Health, Epidemiology, or a related field.
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Statistical Software: SAS, R, Python. Data Visualization Tools: Tableau, Power BI, ggplot2 (in R) Proficiency in data manipulation, analysis, and visualization using tools such as SQL, Python, R, SAS, or similar.
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