Provider Quality Liaison

Centene Corporation

12d•$19 - $33•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. Candidate must reside in Arkansas. Position is hybrid, requiring 50-75% travel to provider offices. Prior experience in quality improvement, provider education, or population health strongly 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), 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.
Candidate must reside in Arkansas.
Position is hybrid, requiring 50-75% travel to provider offices.

Nice To Haves

Associate’s degree preferred.
Prior experience in quality improvement, provider education, or population health strongly preferred.
Pharmacy Technician, Medical Assistant Licensed Vocational Nurse, Licensed Practical Nurse, Social Work licensure preferred.

Responsibilities

Connecting with plan providers regarding quality initiatives and key quality performance indicators.
Sharing HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers.
Collaborating 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.
Referencing and connecting 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.
Acting as an ongoing resource to providers for quality improvement via regular touch points and meetings.
Educating, supporting, and resolving 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.
Collaborating with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures).
Providing clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance.
Developing, enhancing and maintaining provider relationship across all product lines (Medicare, Medicaid, Ambetter).
Supporting the development and implementation of quality improvement interventions in relation to Plan providers
Conducting telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps.
Performing other duties as assigned.
Complying with all policies and standards