Quality Practice Advisor

🕒 4 days ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Establish and foster healthy working relationships between large physician practices, IPAs, and Centene • Educate providers and support provider practice sites regarding NCQA HEDIS measures and risk adjustment • Provide education on HEDIS measures, medical record documentation, and appropriate coding • Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS and documentation standards • Act as a resource for health plan peers on HEDIS measures, documentation, and coding • Support development and implementation of quality improvement interventions and provider audits • Advise and educate provider practices and IPAs in HEDIS measures, documentation guidelines, and ICD-9/10 CPT coding • Collect, summarize, trend, and deliver provider quality and risk adjustment performance data • Identify provider improvement and gap-closure opportunities; strategize and coach on interventions • Collaborate with Provider Relations and other provider-facing teams to improve Quality, Risk Adjustment, and Operations performance • Identify practice needs where Centene can provide support • Develop, enhance, and maintain provider clinical relationships across product lines • Maintain Quality KPIs and HEDIS abstraction accuracy rates according to corporate standards • Travel to provider offices as needed, up to 75% of the time • Perform other assigned duties and comply with policies and standards

🎯 Requirements

• Must reside in Louisiana • Location preference is New Orleans or Baton Rouge • HEDIS experience highly preferred • 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, CPC-A or CBCS • RHIT® requirements apply for positions aligned to a corporate line of business operating within a state-specific health plan • Knowledge of NCQA HEDIS measures, medical record documentation, risk adjustment, and HEDIS ICD-9/10 CPT coding • Ability to travel up to 75% of time to provider offices

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation

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