• Lead Abstractor, HEDIS /Quality Improvement…

    Molina Healthcare (Buffalo, 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
    Molina Healthcare (08/08/25)
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  • Senior Overreader, HEDIS /Quality…

    Molina Healthcare (NY)
    … HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. **Job Qualifications** **REQU** **I** **RED ED** **U** **C** ... ad hoc projects. **Job Duties** + Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records reviewed… more
    Molina Healthcare (08/21/25)
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  • Director, Clinical Data Acquisition ( HEDIS…

    Molina Healthcare (Yonkers, NY)
    …for the implementation, monitoring, and oversight of all chart collection for HEDIS , or HEDIS -like projects, Risk Adjustment, Risk Adjustment Data Validation, ... management of training for all CDA team members as well as company HEDIS training, onboarding for CDA team members, vendor management for chart collection vendors,… more
    Molina Healthcare (08/21/25)
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  • Stars Program Delivery Lead - HEDIS…

    Humana (Albany, NY)
    …plan operations. **Location:** Remote or if near Louisville hybrid The Lead for HEDIS Controlling Blood Pressure is responsible for the advancement of the initiative ... operational execution and performance oversight in effort to achieve high HEDIS condition management Stars performance targets. This individual will define… more
    Humana (09/03/25)
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  • HEDIS Clinical Reviewer I (Seasonal)

    Excellus BlueCross BlueShield (Rochester, NY)
    …their home office. Essential Accountabilities: Level I + Conducts medical record review based upon standards outlined in department training manual + Retrieves, ... information as it relates to regulatory requirements, including but not limited to, HEDIS /QARR, CMS and DOH. + Reviews chart abstractions from offshore vendor team +… more
    Excellus BlueCross BlueShield (09/03/25)
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  • Stars Program Delivery Senior Professional…

    Humana (Albany, NY)
    …plan operations. Location: remote or if in Louisville area then hybrid The HEDIS Condition Management team is seeking a passionate and organized teammate to ... accelerate measure improvement efforts to improve HEDIS performance. The Senior Professional strategically identifies, develops, and implements programs that… more
    Humana (09/03/25)
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  • HEDIS Medical Record Retrieval Specialist…

    Excellus BlueCross BlueShield (Utica, NY)
    …limited to requesting and retrieving medical records from providers to the plan for review and for Risk Adjustment Validation Audits (RADV). * Acts as a preceptor to ... new employees during the orientation process. Functions as a resource to existing staff for projects and daily work. Facilitates ongoing training for optimal staff functioning. * Proposes and develops new desk level procedures (DLP's) and policies and… more
    Excellus BlueCross BlueShield (08/25/25)
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  • Manager, Clinical Data Acquisition (Remote)

    Molina Healthcare (Albany, NY)
    …of the performance measurement data collection, reporting and monitoring process, including HEDIS , state-based measure reporting and medical record review . + ... activities. Responsibilities include responding to RFP(s) as needed, development of the HEDIS measures matrix, HEDIS work plans, and all product timelines.… more
    Molina Healthcare (08/31/25)
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  • Consultative Coding Professional

    CenterWell (Albany, NY)
    …post-visit reviews. (Frequency and sampling methodology to be determined) + Review the encounter for potential missed opportunities. + Address nonbillable services ... Perform individual chart research as requested. + Collaborate with HEDIS leaders and champions to identify HEDIS ...with HEDIS leaders and champions to identify HEDIS gaps and deficiencies. + Participate in Payer calls/chart… more
    CenterWell (08/20/25)
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  • Risk & Quality Performance Manager (Remote)

    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
    Molina Healthcare (07/31/25)
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