- Molina Healthcare (Syracuse, NY)
- …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
- MVP Health Care (Schenectady, NY)
- …and continuous improvement. To achieve this, we're looking for a **Medical Director, Clinical Review and Care Integrity** to join #TeamMVP. If you have a passion for ... requirements (eg, CMS, NCQA, DOH) + Knowledge of quality improvement including HEDIS , STAR, CAHPS measures is preferred. + Familiarity with quality improvement and… more
- Molina Healthcare (Albany, NY)
- …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
- Apicha Community Health Center (New York, NY)
- …disparities and social determinants of health. The role encompasses analysis and review of trends and projections of key clinical metrics, supporting new program ... ongoing quality assurance of data and reports, including NCQA PCMH accreditation, HEDIS /QARR, UDS, and HIV Treatment Cascade + Validate data accuracy of Population… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical ... clinical reviews with attending physicians or other providers to discuss review determinations with providers and external physicians. + Conduct clinical appeal… more
- Datavant (Albany, NY)
- …+ 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 (Albany, NY)
- …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 (Rochester, NY)
- …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 (Buffalo, NY)
- …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 (Buffalo, NY)
- …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
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