Quality Improvement Advisor – HEDIS & Provider Relations

Centene Corporation; North Carolina; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Corporation in North Carolina is seeking a Healthcare Quality Educator to establish and foster productive relationships between large physician practices, IPAs and Centene. The role educates providers on NCQA HEDIS measures, documentation and coding to support plan compliance.

Travel up to 75% is required, and RN licensure is highly preferred. The position requires a Bachelor's degree and at least 3 years in HEDIS record collection and risk adjustment, with multiple certifications as

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• Licenses/Certifications: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, CBCS.
• RHIT® certification: applicable to state-specific roles.

Responsibilities

• Delivers, advises and educates provider practices and IPAs in HEDIS measures and coding.
• Collects, summarizes trends, and delivers provider quality and risk adjustment data to improve performance.
• Collaborates with Provider Relations to improve provider performance in Quality and Risk Adjustment.
• 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 per corporate standards.
• Ability to travel up to 75% to provider offices.
• Performs other duties as assigned.
• Complies with policies and standards.

Job description

Centene Corporation in North Carolina is seeking a Healthcare Quality Educator to establish and foster productive relationships between large physician practices, IPAs and Centene. The role educates providers on NCQA HEDIS measures, documentation and coding to support plan compliance.

Travel up to 75% is required, and RN licensure is highly preferred. The position requires a Bachelor's degree and at least 3 years in HEDIS record collection and risk adjustment, with multiple certifications as