Provider Quality Liaison

Centene Corporation•Remote-NV, NV

2d•$19 - $33•Hybrid

About The Position

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), Disenrollments, 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

High school diploma or equivalent.
2+ years of experience with clinical and member experience quality.
Driver’s License required.

Nice To Haves

Associate’s degree preferred.
Experience in HEDIS.
Experience in provider engagement.
Experience in healthcare quality improvement initiatives.
Pharmacy Technician, Medical Assistant Licensed Vocational Nurse, Licensed Practical Nurse, Social Work licensure preferred.

Responsibilities

Connect with plan providers regarding quality initiatives and key quality performance indicators.
Share HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers.
Collaborate with provider offices and internal partners on performance measure barriers, actions to mitigate low performing measures, and the sharing of quality best practices.
Educate provider practices in appropriate HEDIS measures, medical record documentation guidelines and Member Experience measures.
Act as an ongoing resource to providers for quality improvement via regular touch points and meetings.
Educate, support, and resolve provider practice sites issues around P4P, RxEffect, CAHPS, HOS, CTMs, Disenrollments, Appeals, and Grievances.
Collaborate with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures).
Provide clear insight into provider group dynamics, identify areas of opportunity, build action plans and collaborate cross functionally to support quality performance.
Develop, enhance and maintain provider relationships across all product lines (Medicare, Medicaid, Ambetter).
Support the development and implementation of quality improvement interventions in relation to Plan providers.
Conduct telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps.
Perform other duties as assigned.
Comply with all policies and standards.