HEDIS Quality Practice Advisor: Provider Education

centene; United States; Hybrid; USD 3,720,000 - 6,750,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a Quality/Provider Educator to support NCQA HEDIS initiatives within Southeast Pennsylvania. You will educate community physicians and small practices on HEDIS measures, documentation, and coding to improve plan performance.

Travel up to 75% is required as you collaborate with providers and collect performance data to drive gap-closure opportunities while ensuring regulatory compliance.

Qualifications

• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience.
• A Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field is preferred.
• 1+ year of experience in related HEDIS medical record review or quality improvement or 2 years medical coding or transferable experience.

Responsibilities

• Educates community physicians and small provider practices in HEDIS measures, medical record documentation guidelines and NCQA coding.
• Collects, summarizes and trends provider performance data to identify opportunities for improvement.
• Collaborates with Provider Relations to improve provider performance in Quality, Risk Adjustment and Operations.
• Provides education and coaching to close gaps with providers.
• Identifies practice needs where WellCare can provide support to improve outcomes.
• Encourages member clinical participation in wellness and education.
• Documents action plans and outcomes from visits with providers.
• Ensures documentation complies with state regulations and deadlines.

Skills

HEDIS measures

Medical coding

Provider education

Data analysis

Quality improvement

Education

Bachelor's degree in healthcare or related field

Master's degree preferred

Job description

Centene is seeking a Quality/Provider Educator to support NCQA HEDIS initiatives within Southeast Pennsylvania. You will educate community physicians and small practices on HEDIS measures, documentation, and coding to improve plan performance.

Travel up to 75% is required as you collaborate with providers and collect performance data to drive gap-closure opportunities while ensuring regulatory compliance.