HEDIS Quality Practice Advisor — Travel Up to 75%

Centene Corporation; Carson City (NV); On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation seeks a HEDIS Education Specialist to educate providers and support NCQA/HEDIS measures across plans. The role emphasizes education on medical record documentation, coding practices, and risk adjustment to meet state and federal standards.

Candidate will analyze provider performance data, collaborate with provider relations, and travel up to 75% to provider offices. Requires Nevada residency and active licenses such as CCS, LPN, RN, or CPC among others.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Current licensure/certification: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS.
• Must reside in Nevada with ability to travel up to 75%.

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures and coding.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data.
• Collaborates with Provider Relations to improve provider performance in Quality, Risk Adjustment and Operations.
• Identifies specific practice needs where Centene can provide support.
• Develops and maintains provider clinical relationships across product lines.
• Maintains Quality KPI and HEDIS abstraction accuracy.
• Travels up to 75% to provider offices.
• Performs other duties as assigned.

Skills

HEDIS knowledge

Provider education

Quality improvement

Risk adjustment

Education

Bachelor's Degree or equivalent

Job description

Centene Corporation seeks a HEDIS Education Specialist to educate providers and support NCQA/HEDIS measures across plans. The role emphasizes education on medical record documentation, coding practices, and risk adjustment to meet state and federal standards.

Candidate will analyze provider performance data, collaborate with provider relations, and travel up to 75% to provider offices. Requires Nevada residency and active licenses such as CCS, LPN, RN, or CPC among others.