Quality Practice Advisor

🕒 September 25

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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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 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 coding • Assist in resolving deficiencies affecting plan compliance with state and federal HEDIS and documentation standards • Serve as a resource for health plan peers • Support development and implementation of quality improvement interventions and provider-related audits • Deliver, advise, and educate provider practices and IPAs on HEDIS measures, documentation guidelines, and HEDIS ICD-9/10 CPT coding • Collect, summarize, trend, and deliver provider quality and risk adjustment performance data • Identify and strategize on provider improvement and gap closure opportunities • Collaborate with Provider Relations and other provider-facing teams • 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 standards • Comply with all policies and standards • Perform other duties as assigned

🎯 Requirements

• Candidates must reside in Nevada • Bachelor's Degree or equivalent required • 3+ years in HEDIS record collection and risk adjustment (coding) required • One active license or certification required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS • Ability to travel up to 75% of the time to provider offices • Knowledge of HEDIS measures, medical record documentation, and appropriate coding • Preferred: provider experience, HEDIS knowledge, medical coding experience, quality improvement experience, and health plan experience

🏖️ 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