Pediatric RN- Quality Practice Advisor

Centene Management Company•Columbia, SC

11d•$27 - $48•Hybrid

About The Position

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. NOTE: This is a work-from-home, hybrid remote (up to 50% travel) role that meets virtually and in person with provider groups based in South Carolina to discuss and improve HEDIS performance. Typical daily tasks will include creating/using PowerPoint presentations, creating/exporting reports, and data analysis. Preference will be given to applicants who (1) reside in South Carolina, (2) have a pediatric background, and (3) an active RN license. Additional Details: Department: MED-Quality Improvement Business Unit: Absolute Total Care Schedule: Mon – Fri, 8am – 5 pm CT Territory: Typically no more than 2 hours from residence. 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.

Requirements

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, CPC-A or CBCS Registered Health Information Technician (RHIT®)

Nice To Haves

reside in South Carolina
have a pediatric background
an active RN license

Responsibilities

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.