Associate Quality Practice Advisor

Centene; United States; Vor Ort; USD 37.000 - 67.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Hybrid/remote-friendly options

Zusammenfassung

Centene seeks an Associate Quality Practice Advisor to partner with providers across Southwest Michigan. The role educates on HEDIS measures, NCQA coding guidelines, and medical record documentation to improve plan compliance and quality of care.

The ideal candidate will have quality-focused experience, provider-facing skills, and be willing to travel up to 50% to counties including Berrien, Cass, St. Joseph, Van Buren, Kalamazoo, and Calhoun.

Qualifikationen

• 1+ year in HEDIS medical record review or quality improvement with data/chart reviews.
• 2+ years medical coding or transferable experience with provider education.

Aufgaben

• Educates community physicians and small provider practices on HEDIS measures and NCQA coding guidelines.
• Collects and trends provider performance data to identify improvement opportunities.
• Collaborates with Provider Relations to improve Quality, Risk Adjustment and Operations.
• Coaches providers on gap closing opportunities and action plans.
• Partners with physicians and staff to promote member participation in wellness programs.

Kenntnisse

HEDIS knowledge

Provider education

Quality improvement

Medical coding

Data analysis

Ausbildung

Bachelor's Degree in Healthcare or related field

Master's Degree in Healthcare or related field (preferred)

Jobbeschreibung

Position Purpose:

Establishes and fosters a healthy working relationship between community physician and small provider practices and WellCare. Educates providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS.

Key Details:

Centene is hiring an Associate Quality Practice Advisor to partner with providers across Southwest Michigan. The ideal candidate will have strong quality experience, including presenting to and partnering with providers, and will be based in Berrien, Cass, St. Joseph, Van Buren, Kalamazoo, or Calhoun County. This role requires up to 50% travel .

Responsibilities:

• Under general guidance from Senior Quality Practice Advisors and management, educates community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.
• Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement.
• Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
• Assists in delivering provider specific metrics and coaches providers on gap closing opportunities.
• Assists in identifying specific practice needs where WellCare can provide support.
• Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education.
• Provides resources and educational opportunities to provider and staff.
• Captures concerns and issues in action plans as agreed upon with provider.
• Documents action plans and details of visits and outcomes.
• Reports critical incidents and information regarding quality of care issues.
• Communicates with external data sources as needed to gather data necessary to measure identified outcomes.
• Provides communication such as newsletter articles, member education, outreach interventions and provider education.
• Supports quality improvement HEDIS and program studies as needed, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.
• Enter documentation of findings in identified databases and ensure accuracy in medical records for data collection, DE and reporting.
• Performs other duties as assigned.
• Complies with all policies and standards

Education/Experience:

Required A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role. Preferred: A Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field. Candidate Experience: Required: 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff OR 2 years medical coding or other transferable experience and skill set combination that demonstrates the ability to learn and perform the level of the position.

Preferred Licenses:

• Certified Coding Specialist (CCS)
• Licensed Practical Nurse (LPN)
• Licensed Master Social Work (LMSW)
• Licensed Vocational Nurse (LVN)
• Licensed Mental Health Counselor (LMHC)
• Licensed Marital and Family Therapist (LMFT)
• Licensed Certified Social Worker (LCSW)
• Licensed Registered Nurse (RN)
• Acute Care Nurse Practitioner (APRN) (ACNP-BC)
• Other Foreign trained physician/MD
• Health Care Quality and Management (HCQM)
• Certified Healthcare Professional (CHP)
• Certified Professional in Healthcare Quality (CPHQ)

Pay Range:

$27.02 - $48.55 per hour

About Centene:

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybr