- Molina Healthcare (NE)
- …Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Mentor entry and Sr. level abstractors. + Works ... Performs the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers… more
- Molina Healthcare (Lincoln, NE)
- …to roadmap of deliverables and timelines and implementing solutions to maximize national HEDIS audit success. * Partner with other teams to ensure data quality ... communicate risks and issues to stakeholders and leadership. * Create, review , and approve program documentation, including plans, reports, and records. *… more
- Prime Therapeutics (Lincoln, NE)
- …to support the Centers for Medicare & Medicaid Services (CMS) Star and HEDIS quality measure programs, including but not limited to: Medication Therapy Management ... qualified members' medications and disease states related to the Star and HEDIS quality measures programs and processes. **Responsibilities** + Receive inbound and… more
- Datavant (Lincoln, NE)
- …+ Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. + Familiarity with HIPAA patient privacy requirements. + Excellent ... protected status. To learn more about our commitment, please review our EEO Commitment Statement here (https://www.datavant.com/eeo-commitment-statement) . Know Your… more
- CenterWell (Lincoln, NE)
- …physician for nurse practitioners or physician assistants, including completing regular chart review and coordinating monthly meetings. . Be available to act as a ... . Meet with clinic leaders about quality of care, review of outcome data, policy, procedure, and records issues....Knowledge of Medicare guidelines and coverage . Knowledge of HEDIS quality indicators . Experience working in value-based care… more
- Molina Healthcare (NE)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more
- Molina Healthcare (Lincoln, NE)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and appeals process. + Contributes to projects aimed at improving Star ratings, HEDIS , CAHPS, and other quality metrics. + Assists call center pharmacy technicians… more
- Molina Healthcare (Omaha, NE)
- …for reporting purposes and maintains files of confidential information submitted for review . + Assures that activities and processes are compliant with NCQA ... and Health Education programs including, but not limited to, NCQA Accreditation, HEDIS , and Disease Management programs company wide. + Attends State and Health… more
- Molina Healthcare (Bellevue, NE)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... Medicaid eligible members as well as Medication Adherence Programs for STAR, HEDIS and behavioral health medications. * Ensures that adequate staffing coverage is… more
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