The Chart Retrieval Specialist manages and abstracts member health records across various Electronic Health Record systems for risk adjustment audits. They are responsible for consolidating data from provider offices and meeting daily and weekly project goals.
The Manager, STARS is responsible for developing and implementing quality improvement strategies to ensure the health plan achieves NCQA accreditation and maintains a 4+ STAR rating. This role involves managing member experience surveys, coordinating with internal and external stakeholders, and providing training to staff on quality initiatives.
The Clinical STARS Specialist manages care gaps through data entry, referral tracking, and telephonic outreach to members and providers. They also educate providers on quality metric guidelines and conduct medical record audits to ensure compliance with CMS standards.
The representative is responsible for ensuring provider data integrity and managing provider directory categorization. They also handle provider inquiries, assist with network development, and ensure compliance with CMS and NCQA standards.
This role manages member experience improvement initiatives, including survey ratings and NCQA accreditation processes. The manager also develops training materials and collaborates with internal and external stakeholders to meet quality performance standards.
The Clinical Quality Specialist manages care gaps through data entry, referral tracking, and provider outreach. They also educate providers on quality metric guidelines and conduct medical record audits to ensure compliance with CMS standards.
Perform telephonic case management for high-risk members to improve long-term wellness through care coordination and monitoring. Educate members and caregivers on self-management techniques and coordinate services with providers and community resources.
