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Clinical Quality, Public Health or Healthcare, Certified Professional in Health Quality (CPHQ), Certified HEDIS Compliance Auditor (CHCA) preferred. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
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Educates members and facilitates HEDIS gap closure. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
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CenterWell is seeking a Clinic Center Administrator/Manager, that develops and leads implementation for staffing plans, policies and procedures for the facility and works closely with clinicians to ensure optimal patient outcomes and company initiatives including but not limited to Quality, HEDIS / STARs, AHCA, financial management and employee and patient retention.
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Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
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Acts as HEDIS champion for the PCP by providing visibility of HEDIS needs for scheduled patients. Acts as HEDIS champion for the PCP by providing visibility of HEDIS needs for scheduled patients.
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Experience with NCQA, HEDIS, Pharmacy benefit management, managed care, quality improvement. The Medical Director, Population Health reporting to our SVP, Chief Medical Officer is responsible for ensuring our 2 million+ advocacy members are receiving high quality, evidence-based care in alignment with the Quintuple Aim. The Medical Director works with a multidisciplinary care team, providing care plan oversight and guidance for medically complex, high-need members in our care management and population health management programs.
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The Alumni Coordinator is responsible for contacting all adult clients and the parents of adolescent clients post-discharge to foster alumni engagement, continuity of care, and HEDIS purposes. The Alumni Coordinator is responsible for contacting all adult clients and the parents of adolescent clients post-discharge to foster alumni engagement, continuity of care, and HEDIS purposes.
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Collaborates with the Analytics department for comprehensive quality data analytics and HEDIS abstraction for required VBC custom reports. Also responsible for executing the local Medicare Stars work plan, with interventions aimed at enhancing HCC coding, Clinical Documentation, CAHPS, HEDIS, and HOS scores.
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Employee discounts to various stores, amusement parks, events, etc. Assists facilities in coordinating alumni meetings and events. Outreach to clients at regular touchpoints to provide information on alumni services and to facilitate outcome data collection on target indicators.
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3+ years experience of direct provider-facing experience or direct health plan experience with STARS, HEDIS, Risk Adjustment and medical expense reduction specific to Medicare Advantage required.
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Knowledge of Medicare guidelines and coverage Bilingual is a plus Knowledge of HEDIS quality indicators preferred Additional Information: Guaranteed base salary + semi-annual bonus Excellent benefit package health insurance effective on your first day of employment CME Allowance/Time Occurrence Based Malpractice Insurance 401(k) with Employer Match Life Insurance/Disability Job Requisition: Paid Time Off/Holidays Minimal Call Scheduled Weekly Hours40.
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Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models. Knowledge of the Healthcare industry including physician practices, market access, insurance, managed care, organized delivery systems, STARs/HEDIS, Value based care and risk adjustment models.
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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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Knowledge of HEDIS measures preferred. The Business Information Analyst Senior is responsible for analyzing, reporting, and developing recommendations on data related to complex and varied business metrics.
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