• HEDIS Analyst

    Medical Mutual of Ohio (OH)
    …ensure data integrity and chart collection. + Produces routine to moderately complex HEDIS reporting to support clinical Quality initiatives to improve member ... Maintains up-to-date knowledge and understanding of technical specifications for all HEDIS measures.Leads collaborative review of mapping documentation for… more
    Medical Mutual of Ohio (08/16/25)
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  • Lead Abstractor, HEDIS /Quality Improvement…

    Molina Healthcare (Savannah, GA)
    …Team, Regional HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results. + Mentor entry and Sr. level abstractors. + Works ... lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing...vendors for the medical record collection process. + Assists Manager and Supervisor(s) in training, utilizing the standardized training… more
    Molina Healthcare (08/08/25)
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  • Remote HEDIS Abstractor $20/HR

    TEKsystems (New York, NY)
    100% REMOTE JOB OPPORTUNITY FOR HEDIS ABSTRACTORS - MUST HAVE PRIOR HEDIS EXPERIENCE EQUIPMENT PROVIDED THIS JOB OPPORTUNITY IS A 3 MONTH CONTRACT MONDAY - ... FRIDAY 8AM-5PM EASTERN TIME $20/HR Qualifications: + 2 years of HEDIS abstraction experience + EMR experience + Medical records experience + Microsoft Office… more
    TEKsystems (08/27/25)
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  • Manager , Clinical Data Acquisition…

    Molina Healthcare (Lexington, KY)
    …of the performance measurement data collection, reporting and monitoring process, including HEDIS , state-based measure reporting and medical record review . + ... surveys and federal/state QI compliance activities. **Job Duties** + The Mgr, Clinical Data Acquisition uses knowledge, skills and technical expertise to manage the… more
    Molina Healthcare (08/31/25)
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  • Clinical Pharmacist - Collaborative…

    ChenMed (Berwyn, IL)
    …medication use, improve patient outcomes, and enhance CMS Star Ratings and HEDIS quality measures. This position requires advanced clinical judgment, effective ... our team. The Medication Adherence Pharmacist is an innovative and patient-focused clinical pharmacist embedded within a defined market of primary care clinics. This… more
    ChenMed (08/20/25)
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  • Case Manager , RN or Licensed Behavioral…

    Excellus BlueCross BlueShield (Dewitt, NY)
    …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... drivers. Essential Accountabilities: Level I + Handles physical health member clinical management programs. + Maintains knowledge of current Case Management Society… more
    Excellus BlueCross BlueShield (08/28/25)
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  • Provider Relations Senior Manager

    CVS Health (Downers Grove, IL)
    …experience to ensure successful provider relationship, network performance including clinical , and affordability targeted improvements as identified and overall ... to obtain crucial or required information from Providers, such as HEDIS , Revalidation, Grievance and Appeals, SIU, etc. Coordinate provider status information… more
    CVS Health (08/21/25)
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  • Associate Medical Director

    CenterWell (Jacksonville, FL)
    …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS , meeting local and organizational goals +… more
    CenterWell (07/22/25)
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  • Medical Director - Sharp Health Plan - Hybrid…

    Sharp HealthCare (San Diego, CA)
    …process. + Participates in risk management, pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review ... all clinical appeals and grievances. Collaborates with Customer Care Manager to identify trends in grievances. Supervises the process for identifying Potential… more
    Sharp HealthCare (08/17/25)
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  • Senior Medical Director - Sharp Health Plan…

    Sharp HealthCare (San Diego, CA)
    …and oversees the health care needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its' Chief Medical Officer. ... in risk management reviews. + Assists in pharmacy utilization management, catastrophic case review , outreach programs, HEDIS reporting, site visit review more
    Sharp HealthCare (07/19/25)
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