Quality Practice Advisor

Centene Management Company LLC; Nevada (IA); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

PTO + holidays

Flexible work arrangements

Job summary

Centene Management Company LLC seeks a provider education and quality improvement professional to educate physicians and IPAs on NCQA HEDIS measures and risk adjustment, supporting documentation and coding across plan providers.

This role involves travel up to 75% to provider offices, collaboration with Provider Relations, and ongoing education to improve HEDIS performance and plan compliance with state and federal standards.

Qualifications

• 3+ years experience in HEDIS record collection and risk adjustment (coding).
• Educates providers on NCQA HEDIS measures and risk adjustment.
• Travels up to 75% to provider offices; collaborates with Provider Relations.

Responsibilities

• Deliver provider education on HEDIS measures and documentation guidelines.
• Coach providers on coding (HEDIS ICD-9/10 CPT) and risk adjustment.
• Collaborate with health plan teams to improve provider performance and gap closure.

Skills

HEDIS knowledge

Quality improvement

Provider education

Data analysis

Risk adjustment understanding

Education

Bachelor's Degree or equivalent

Job description

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.

Key Details

Candidates must reside in Nevada, as this position requires occasional travel. One of the following active licenses or certifications is required:

• CCS
• LPN
• LCSW
• LMHC
• LMSW
• LMFT
• LVN
• RN
• APRN
• HCQM
• CHP
• CPHQ
• CPC
• CPC-A
• CBCS

Preferred qualifications include provider experience, HEDIS knowledge, medical coding experience, quality improvement experience, and health plan experience. 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
• CBCS

Pay Range

$27.02 - $48.55 per hour

About Centene

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.

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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.

Equal Opportunity

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.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.