Quality Practice Advisor

Centene Corporation; Asheville (NC); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corporation in North Carolina is seeking a field-focused quality educator to advance HEDIS measures and risk adjustment across provider networks. This hybrid role requires NC residency and up to 75% travel to physician offices. RN or related licensure is highly preferred.

You will educate providers on HEDIS measures, assist with documentation review, and coordinate with Provider Relations to improve performance while ensuring compliance with NCQA standards and payers.

Qualifications

• Bachelor's Degree or equivalent required.
• 3+ years in HEDIS record collection and risk adjustment (coding) required.
• RN/LPN/LCSW/LMHC/LMSW/LMFT/LVN/RN/APRN/HCQM/CHP/CPHQ/CPC/CPC-A or CBCS licensure specified.

Responsibilities

• Delivers, educates and advises provider practices on HEDIS measures and coding.
• Collects, summarizes, trends, and delivers provider quality data to identify improvement opportunities.
• Collaborates with Provider Relations to improve performance in Quality and Risk Adjustment.
• Identifies provider needs where Centene can provide support.
• Develops and maintains provider clinical relationships across product lines.
• Maintains Quality KPI and HEDIS abstraction accuracy.

Skills

HEDIS knowledge

Risk adjustment

Provider education

Education

Bachelor's Degree or equivalent

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT

*This position is a hybrid role that requires fieldwork. Qualified candidates must reside in the state of North Carolina in one of the following counties: Avery, Buncombe, Burke, Caldwell. Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, or Yancey*

RN licensure highly preferred.

Position Purpose

Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. 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 and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.

• Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
• Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
• Identifies specific practice needs where Centene can provide support.
• Develops, enhances and maintains provider clinical relationship across product lines.
• Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
• Ability to travel up to 75% of time to provider offices.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience

Bachelor's Degree or equivalent required
3+ years in HEDIS record collection and risk adjustment (coding) required

Licenses/Certifications

One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS

Registered Health Information Technician (RHIT®): For positions aligned to a corporate line of business that report into and operate within a state specific health plan, state requirements apply

Pay Range: $27.02 - $48.55 per hour

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