Provider Quality Liaison

Centene Management Company LLC; United States; Hybrid; USD 27,000 - 45,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements (remote,hyb

Job summary

Centene Management Company LLC is seeking a Quality Engagement Specialist to connect with plan providers on quality initiatives and share HEDIS, CAHPS, and related reports. You will collaborate with internal teams to address barriers and promote best practices in quality performance.

The role requires Nevada residency with willingness to travel, 2+ years in healthcare quality, and familiarity with P4P, CAHPS, HEDIS. A valid driver's license is required; licensure in related fields is preferred.

Qualifications

• High school diploma or equivalent required; Associate degree preferred.
• 2+ years of experience in clinical and member experience quality.
• Experience with HEDIS, provider engagement, and healthcare quality initiatives.

Responsibilities

• Educates, supports, and resolves provider practice sites issues around P4P, RxEffect, CAHPS, HOS, CTMs, Disenrollments, Appeals, and Grievances.
• Connects providers with resources to educate practices in HEDIS measures and documentation guidelines.
• Ongoing provider quality improvement via regular touchpoints and meetings.
• Collaborates with Provider Relations and other provider-facing teams to improve provider performance in quality and member experience.
• Develops and maintains provider relationships across products (Medicare, Medicaid, Ambetter) and supports quality interventions.

Skills

Provider engagement

Quality improvement

HEDIS knowledge

CAHPS knowledge

Telephonic outreach

Education

High school diploma or equivalent

Associate degree preferred

Job description

Position Purpose:

Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators. Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers. Use existing resources to collaborate with provider offices and internal partners on performance measure barriers, actions to mitigate low performing measures, and the sharing of quality best practices to support providers.

Key Details:

Candidates must reside in Nevada, with preference given to those located in Northern Nevada. The ideal candidate will be willing to travel as needed and possess experience in HEDIS, provider engagement, and healthcare quality improvement initiatives.

• References and connects providers with existing resources to educate provider practices in appropriate HEDIS (Healthcare Effectiveness Data and Information Set) measures, medical record documentation guidelines and Member Experience measures.
• Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings.
• Educates, supports, and resolves provider practice sites issues around P4P (Pay for Performance), RxEffect, CAHPS (Consumer Assessment of Healthcare Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollments, Appeals, and Grievances.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures). Provides clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance.
• Develops, enhances and maintains provider relationship across all product lines (Medicare, Medicaid, Ambetter). Supports the development and implementation of quality improvement interventions in relation to Plan providers.
• Conducts telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

High school diploma or equivalent. Associate’s degree preferred. 2+ years of experience with clinical and member experience quality.

License/Certification:

Driver’s License required. Pharmacy Technician, Medical Assistant Licensed Vocational Nurse, Licensed Practical Nurse, Social Work licensure preferred.

Pay Range: $19.43 - $32.98 per hour

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.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.