• Lead Abstractor, HEDIS /Quality Improvement…

    Molina Healthcare (TX)
    …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 (07/17/25)
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  • Data Analyst IV

    Centene Corporation (Austin, TX)
    …of the following areas: claims, provider data, member data, clinical data, HEDIS , pharmacy, external reporting + Extract, load, model, and reconcile large amounts ... of data across multiple system platforms and sources + Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement… more
    Centene Corporation (08/03/25)
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  • Risk & Quality Performance Manager (Remote)

    Molina Healthcare (Houston, TX)
    …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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  • Medication Therapy Management (MTM) Technician

    Prime Therapeutics (Austin, TX)
    …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
    Prime Therapeutics (07/16/25)
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  • Senior Client Coding Project Manager

    Datavant (Austin, TX)
    …+ 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
    Datavant (06/28/25)
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  • PRN - Virtual Physician Collaborator (Remote)

    CenterWell (Austin, TX)
    …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
    CenterWell (08/02/25)
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  • Associate Medical Director- Dallas

    CenterWell (Arlington, TX)
    …quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments ... experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals + Personally deliver high-quality primary… more
    CenterWell (07/18/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Dallas, TX)
    …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 (06/29/25)
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  • CenterWell- Physician- Beaumont/Port Arthur

    CenterWell (Beaumont, TX)
    …defined by Clinical Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... environment . Knowledge of Medicare guidelines and coverage. Knowledge of HEDIS quality indicators Additional Information:. Excellent benefit package - health… more
    CenterWell (07/28/25)
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  • Pharmacist, Utilization Management (UM)

    Molina Healthcare (Fort Worth, TX)
    …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 (07/27/25)
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