Associate Quality Practice Advisor

🔥 0 minutes ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

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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 community physicians, small provider practices and WellCare • Educate providers and support provider practice sites regarding NCQA HEDIS measures • Provide education on HEDIS measures, medical record documentation and appropriate coding • Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS standards • Collect, summarize and trend provider performance data to identify improvement opportunities • Collaborate with Provider Relations to improve Quality, Risk Adjustment and Operations performance • Deliver provider-specific metrics and coach providers on gap-closing opportunities • Identify practice needs where WellCare can provide support • Partner with physicians and staff to encourage member clinical participation in wellness and education • Provide resources and educational opportunities to providers and staff • Capture concerns and issues in provider action plans • Document action plans, visit details and outcomes • Report critical incidents and quality-of-care issues • Gather data from external sources as needed to measure outcomes • Create newsletters, member education, outreach interventions and provider education • Support HEDIS quality-improvement and program studies, including requesting records, maintaining databases and researching provider encounter history • Ensure documentation complies with state regulations and accrediting-body requirements • Ensure regulatory report content is accurate and submitted by deadlines • Enter findings into databases and ensure medical-record data accuracy • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field, or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets • 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff, OR 2 years medical coding or other transferable experience and skill set combination • Strong quality experience, including presenting to and partnering with providers • Knowledge of HEDIS measures, medical record documentation and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements • Ability to collect, summarize and trend provider performance data • Ability to provide consultation and education to providers and provider staff • Up to 50% travel required • Preferred: Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field • Preferred license/certification: CCS, LPN, LMSW, LVN, LMHC, LMFT, LCSW, RN, APRN (ACNP-BC), foreign-trained physician/MD, HCQM, CHP or CPHQ

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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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