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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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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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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 - 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.
$90,000 - $110,000 a yearFull-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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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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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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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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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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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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Nursing interns will be aligned to one of the following areas below (opportunities may vary by market): Case Management Assist the provider/nursing team with various care coordination activities Collaborates with all key stakeholders; providers, nursing homes/assisted living facilities, PCPs, families, interdisciplinary care teams and any other identified stakeholders Assist with identifying gaps in the HEDIS/Quality measures and communicating these to the provider for resolution.
InternExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Overseeing the coordination of HEDIS data ingestion activities and driving strategy to optimize HEDIS data ingestion, EHR/HIE interoperability, supplemental data, and record review for the Medicaid line of business.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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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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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 7 days ago - UpvoteDownvoteShare Job
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This position will assist with projects to improve HEDIS and Star measure outcomes, manage contractual requirements mandated by the state and CMS, and participate in performance improvement projects by analyzing and interpreting data to ensure we meet standards.
Full-timeRemoteExpandApply NowActive JobUpdated 6 days ago
hedis job Company: Remote Career Jobs
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