Provider Quality Liaison

Centene Corporation

1d • $19 - $33

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. 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. Candidates must reside in Wisconsin and be able to travel up to 30%, including in‑person provider visits in Waukesha, Dane, and Milwaukee counties, along with virtual and telephonic engagement. The ideal candidate will have healthcare experience, preferably working with providers and community partners, strong communication skills, the ability to interpret data, and be organized, independent, detail‑oriented, and able to manage multiple priorities and deadlines. A valid driver’s license is required. LPN or LVN licensure preferred. Position Purpose: Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators. Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers. Use existing resources to collaborate with provider offices and internal partners on performance measure barriers, actions to mitigate low performing measures, and the sharing of quality best practices to support providers. References and connects providers with existing resources to educate provider practices in appropriate HEDIS (Healthcare Effectiveness Data and Information Set) measures, medical record documentation guidelines and Member Experience measures. Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings. Educates, supports, and resolves provider practice sites issues around P4P (Pay for Performance), RxEffect, CAHPS (Consumer Assessment of Healthcare Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollment's, Appeals, and Grievances. Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures). Provides clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance. Develops, enhances and maintains provider relationship across all product lines (Medicare, Medicaid, Ambetter). Supports the development and implementation of quality improvement interventions in relation to Plan providers Conducts telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps. Performs other duties as assigned. Complies with all policies and standards

Requirements

• 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.
• Candidates must reside in Wisconsin and be able to travel up to 30%, including in‑person provider visits in Waukesha, Dane, and Milwaukee counties, along with virtual and telephonic engagement.
• The ideal candidate will have healthcare experience, preferably working with providers and community partners, strong communication skills, the ability to interpret data, and be organized, independent, detail‑oriented, and able to manage multiple priorities and deadlines.
• A valid driver’s license is required.
• High school diploma or equivalent.
• 2+ years of experience with clinical and member experience quality.
• Driver’s License required.

Nice To Haves

• LPN or LVN licensure preferred.
• Associate’s degree preferred.
• Pharmacy Technician, Medical Assistant Licensed Vocational Nurse, Licensed Practical Nurse, Social Work licensure preferred.

Responsibilities

• Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators.
• Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers.
• Use existing resources to collaborate with provider offices and internal partners on performance measure barriers, actions to mitigate low performing measures, and the sharing of quality best practices to support providers.
• References and connects providers with existing resources to educate provider practices in appropriate HEDIS (Healthcare Effectiveness Data and Information Set) measures, medical record documentation guidelines and Member Experience measures.
• Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings.
• Educates, supports, and resolves provider practice sites issues around P4P (Pay for Performance), RxEffect, CAHPS (Consumer Assessment of Healthcare Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollment's, Appeals, and Grievances.
• Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures).
• Provides clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance.
• Develops, enhances and maintains provider relationship across all product lines (Medicare, Medicaid, Ambetter).
• Supports the development and implementation of quality improvement interventions in relation to Plan providers
• Conducts telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps.
• Performs other duties as assigned.
• Complies with all policies and standards

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED