Associate Quality Practice Advisor

Centene Corporation•Remote-MI, MI

2d•$27 - $49

About The Position

The Associate Quality Practice Advisor establishes and fosters relationships between community physicians and small provider practices and WellCare. The role educates providers and supports practice sites on NCQA HEDIS measures, medical record documentation, and appropriate coding, and helps resolve deficiencies that affect compliance with state and federal HEDIS standards. Under general guidance from Senior Quality Practice Advisors and management, the advisor collects and analyzes provider performance data, identifies improvement opportunities, collaborates with Provider Relations, and coaches providers on closing care gaps. The role also identifies practice support needs, encourages member participation in wellness and education, provides educational resources, records agreed-upon action plans and visit outcomes, and reports critical incidents and quality-of-care issues. Additional responsibilities include gathering data from external sources, communicating through provider and member education materials and outreach, supporting HEDIS and quality improvement studies, requesting and reviewing records, maintaining databases, and ensuring documentation and regulatory or contract reports are accurate and submitted on time. The position serves providers across Southwest Michigan, requires up to 50% travel, and may be based in Berrien, Cass, St. Joseph, Van Buren, Kalamazoo, or Calhoun County.

Requirements

Bachelor's degree in healthcare, public health, nursing, psychology, health administration, social work, or a related field, or equivalent managed-care work experience related to HEDIS record review, quality improvement, medical coding, or transferable skills demonstrating ability to perform the role.
At least 1 year of related HEDIS medical record review or quality improvement experience involving data and chart reviews to provide consultation and education to providers and provider staff; OR 2 years of medical coding or other transferable experience and skills demonstrating the ability to learn and perform the role.
Strong quality experience, including presenting to and partnering with providers.
Ability to travel up to 50%.

Nice To Haves

Master's degree in healthcare, public health, nursing, psychology, health administration, social work, or a related field.
A relevant license or credential, such as CCS, LPN, LMSW, LVN, LMHC, LMFT, LCSW, RN, ACNP-BC, foreign-trained physician/MD, HCQM, CHP, or CPHQ.

Responsibilities

Educate community physicians and small provider practices on HEDIS measures, medical record documentation guidelines, and HEDIS ICD-9/10 and CPT coding in accordance with NCQA requirements.
Collect, summarize, and trend provider performance data to identify and plan opportunities for provider improvement.
Collaborate with Provider Relations to improve provider performance in quality, risk adjustment, and operations, including claims and encounters.
Deliver provider-specific metrics and coach providers on opportunities to close care gaps.
Identify practice needs where WellCare can provide support.
Partner with physicians and their staff to encourage member participation in clinical wellness and education.
Provide resources and educational opportunities to providers and staff.
Capture provider concerns and issues in agreed-upon action plans and document plans, visit details, and outcomes.
Report critical incidents and information regarding quality-of-care issues.
Communicate with external data sources to gather data needed to measure outcomes.
Provide communications such as newsletter articles, member education, outreach interventions, and provider education.
Support HEDIS quality improvement and program studies, including requesting provider records, maintaining databases, and researching members' provider encounter history.
Ensure documentation produced or processed complies with state regulations and accrediting body requirements.
Ensure assigned contract and regulatory report content is accurate and submissions meet deadlines.
Enter findings into identified databases and ensure accuracy of medical records used for data collection, DE, and reporting.
Perform other duties as assigned and comply with all policies and standards.