- Excellus BlueCross BlueShield (Rochester, NY)
- …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... all regulatory requirements are being met, such as NYS DOH, CMS, NCQA, and HEDIS , serving as internal auditor within the group. + Responsible for all aspects of… more
- Blue KC (Kansas City, MO)
- …coordination and implementation of retrospective medical record retrieval and review campaigns, prospective provider education programs, regulatory audit activities, ... experience and/or managed care experience. + 5+ years' experience in Risk Adjustment and HEDIS / Stars coding + 3+ years' team lead or project lead experience +… more
- Catholic Health Services (Melville, NY)
- …new staff. Participates in staff meetings and huddles as appropriate. Participates in Hedis , GPRO, and other quality programs as needed Enters provider orders into ... the electronic record for provider review and signature Preforms AWV Patient counseling and instruction on health maintenance goals Position Requirements and… more
- Veterans Affairs, Veterans Health Administration (Kenosha, WI)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... quality outcomes, care coordination, screenings), Healthcare Effectiveness Data and Information Set ( HEDIS ), All Employee Survey scores, and other metrics as to be… more
- CenterWell (San Antonio, 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:** + Guaranteed base salary + bi-annual… more
- CenterWell (Deerfield Beach, FL)
- …defined by Clinical Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... Medicare guidelines and coverage . Bilingual is a plus . Knowledge of HEDIS quality indicators **Additional Information:** . Guaranteed base salary + quarterly bonus… more
- CenterWell (Las Vegas, NV)
- …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 + Bilingual is a plus **Additional Information** Scheduled 8:00… more
- ERP International (Camp Pendleton, CA)
- …Military Health System beneficiaries. Including, but not limited to, all command specific HEDIS metrics. * Track metrics of success as informed by command for ... as needed. * Assist the PHP Project Manager/Senior Strategist in the review , development, and implementation of policies, procedures, processes, and guidelines. *… more
- AmeriHealth Caritas (Manchester, NH)
- …**Responsibilities** + The Market Chief Medical Officer oversees all utilization review techniques, methods, administration, and implementation + They are directly ... goals + The Market CMO is accountable for ACFC quality initiatives to improve HEDIS and other quality ratings and will have substantial involvement in QAPI Program… more
- CenterWell (Delray Beach, FL)
- …defined by Clinical Leadership. + Meets with AMD 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:** . Base salary +bi-annual incentive .… more