Average salary: $84,153 /yearly
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- ...necessity per evidence-based guidelines - Handle prior authorizations and manage appeals/denials - Ensure compliance with CMS, DRG, HEDIS, NCQA, HIPAA, and The Joint Commission standards - Collaborate with interdisciplinary team including social services Compliance...HEDIS16 hoursWeekend work
TLC
Portland, OR1 day ago $2,412 per week
...Medicaid Services, Determine Medical Necessity per Evidence-Based Guidelines*, Discharge Planning, DRG (Diagnosis Related Groups), HEDIS (The Healthcare Effectiveness Data and Information Set) Measures*, HIPAA guidelines (Health Insurance Portability and Accountability...HEDISDaily paid16 hoursPermanent employmentFull timeContract workTemporary workLocal areaShift workNight shiftWeekend workMindlance Health
Portland, OR3 days ago$2,412 per week
...Medicaid Services, Determine Medical Necessity per Evidence-Based Guidelines*, Discharge Planning, DRG (Diagnosis Related Groups), HEDIS (The Healthcare Effectiveness Data and Information Set) Measures*, HIPAA guidelines (Health Insurance Portability and Accountability...HEDISDaily paid16 hoursPermanent employmentFull timeContract workTemporary workLocal areaShift workNight shiftWeekend workTravelNurseSource
Portland, OR3 days ago$2,331 - $2,548.2 per week
...and Medicaid Services, CPT (Current Procedural Terminology) coding and billing, Department of Health, DRG (Diagnosis Related Groups), HEDIS (The Healthcare Effectiveness Data and Information Set) Measures, HIPAA guidelines (Health Insurance Portability and Accountability...HEDIS$21.82 - $42.55 per hour
...Experience: 1 year of experience in Medicaid/Marketplace. Certifications: Certified Professional in Health Quality (CPHQ), Certified HEDIS Compliance Auditor (CHCA). Nursing License (RN) may also be preferred. Compensation Pay Range: $21.82 - $42.55 / HOURLY (may vary...HEDISHourly payWork experience placementRemote workKanz.us
Salem, OR16 hours ago- ...Medicaid, Exchange, and D-SNP populations. This role requires a deep expertise in Medicaid and Medicare quality programs, including HEDIS, HOS, STAR, and CAHPS, and a proven track record in driving measurable improvements in these areas. The Senior Director will also be...HEDIS
- ...units, ensuring smooth transitions and continuity of care. Perform discharge planning and continue stay reviews following CMS and HEDIS guidelines. Assess patient needs and collaborate effectively with interdisciplinary teams. Ensure compliance with HIPAA and...HEDISContract workLocal areaWeekend workDay shift
ARMS Staffing
Portland, OR2 days ago - ...Quality and Clinical Outcomes: Implement programs (and define the demand) to improve clinical quality metrics, including Star ratings (HEDIS, CAHPS, HOS), ensuring integrated care delivery aligns with members needs and organizational goals. Partners with risk adjustment...HEDISWork at officeLocal area
Kaiser Permanente
Portland, OR1 day ago - ...education and communication on Best Practice sharing, process improvement in provider workflows, Kidney Health Management interventions and HEDIS/STAR measures for identified areas of provider low performance Identify opportunities to educate provider offices on topics related...HEDISWork at officeLocal area
$101.2k - $115k
...health insurance industry trends, clinical case management, utilization management practices, and regulatory requirements (CMS, state, HEDIS) Ability to evaluate program effectiveness, identify opportunities for improvement, and manage multiple projects within time...HEDISImmediate startFlexible hoursCambia Health Solutions
Medford, OR2 days ago- ...level administration and management of healthcare clinical measurement utilizing Healthcare Effectiveness Data and Information Set (HEDIS), National Perinatal Information Center (NPIC), National Surgical Improvement Program (NSQIP), Trauma Quality Improvement Program (TQIP...HEDISFull timeContract workFor contractorsWork at officeLocal areaRemote workMonday to Friday
St. George Tanaq Corporation
Salem, OR16 hours ago $72.44k - $126.78k
...Services in executing enterprise cost of care strategies, strategic roadmaps, and quality initiatives that directly impact STARS rating, HEDIS measures, and overall quality performance. This role is pivotal in supporting the alignment of pharmacy services with enterprise-...HEDISWork experience placementWork at officePacificSource
Springfield, OR2 days ago$72.7k
...automated model scoring. ~ Familiarity with call center analytics, provider engagement data, or member experience metrics (CAHPS, HEDIS, STARS). ? Technical Skills Advanced SQL (window functions, CTEs, analytical modeling). Tableau / Tableau Next (LOD expressions...HEDISFor contractorsWork at officeLocal areaHighmark Health
Salem, OR1 day ago$97.9k - $133.5k
...with healthcare data from diverse EHRs, and an understanding of Membership, Medicare Risk Adjustment, and quality metrics (such as HEDIS). Experience working with Snowflake Cloud. Experience with the Azure ecosystem. Familiarity with dbt (data build tool) framework...HEDISFull timeTemporary workApprenticeshipWork at officeRemote workCenterWell
Salem, OR2 days ago$78.4k - $107.8k
...toward these goals. Stars/Quality Program Expertise: Serve as an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience. Collaborate to develop tailored action plans and communicate actionable insights to improve...HEDISBi-weekly payFull timeTemporary workApprenticeshipWork experience placementLive inWork at officeRemote workWork from homeHome officeMonday to FridayFlexible hoursHumana
Salem, OR2 days ago$163.2k - $220.8k
...predictive modeling, and BI tools (Tableau, Power BI) for dashboard developmentHealthcare Quality Standards: Solid understanding of NCQA HEDIS measures, risk adjustment models, value-based care, and population health management principlesProcess Improvement Methodology:...HEDISImmediate startWork from homeFlexible hours$64.87k - $110.28k
...Excel, PowerPoint and Outlook. Preferred Knowledge: Familiarity with Medicare Five-Star, Oregon Quality Incentive Measures and/or NCQA HEDIS, Health Care Payment Learning & Action Network (LAN) and Alternative Payment Model framework, and Facets claims processing system....HEDISFull timeContract workWork experience placementWork at office
