Provider Quality Liaison

Centene Corporation•Remote-NV, NV

3d•$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. 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.
Candidates must reside in Nevada, with preference given to those located in Northern Nevada.
Willing to travel as needed.
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

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.