Quality Practice Advisor

RemoteWorker US; Norman (OK); Remote; USD 60,000 - 80,000; Full time

Job summary

RemoteWorker US is seeking a Quality Practice Advisor to support HEDIS compliance and improve relationships between physician practices and Centene. The ideal candidate will possess a Bachelor's Degree, relevant nursing credentials, and experience in HEDIS record collection. This full-time remote role offers a competitive hourly wage and a comprehensive benefits package.

Benefits

competitive pay

health insurance

401K and stock purchase plans

tuition reimbursement

paid time off plus holidays

Qualifications

• 3+ years in HEDIS record collection and risk adjustment required.
• Educational background in nursing or equivalent required.
• Strong understanding of NCQA requirements.

Responsibilities

• Educates providers on HEDIS measures and supports quality compliance.
• Delivers data to identify improvement opportunities for providers.
• Collaborates with teams to enhance provider performance.

Skills

HEDIS record collection

Risk adjustment (coding)

Education

Bachelor's Degree

CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS

Job description

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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.

THIS POSITION IS REMOTE/WORK FROM HOME. PREFER APPLICANTS WHO RESIDEIN THE STATE OF OKLAHOMA. WILL TRAVEL 10% TO DO PERIODIC PROVIDER OFFICE VISITS IF RESIDES IN OKLAHOMA. THIS ROLE IS SUPPORTING OUR OKLAHOMA COMPLETE HEALTH PLAN.

THE WORK SCHEDULE IS MONDAY - FRIDAY, 8AM - 5PM CENTRAL TIME ZONE. IDEAL APPLICANT WILL BE A NURSE WITH HEDIS BACKGROUND.

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 10% 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

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

Pay Range: $26.50 - $47.59 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. Total compensation may also include additional forms of incentives.

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

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Staffing and Recruiting

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