Quality Practice Advisor

Centene Corporation-posted 10 months ago
$26 - $47/Yr
Full-time
OK
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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. THIS POSITION IS REMOTE/WORK FROM HOME. PREFER APPLICANTS RESIDE IN THE STATE OF OKLAHOMA. WILL TRAVEL APPROXIMATELY 10% OF THE TIME TO DO PERIODIC PROVIDER OFFICE VISITS. WORK SCHEDULE WILL BE MONDAY - FRIDAY 8AM - 5PM CENTRAL TIME ZONE. IDEAL APPLICANT WILL BE A NURSE WITH HEDIS BACKGROUND.

  • 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.
  • Performs other duties as assigned.
  • Complies with all policies and standards.
  • 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, CBCS required.
  • Competitive pay
  • Health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible approach to work with remote, hybrid, field or office work schedules
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