Associate Quality Practice Advisor

🔥 15 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 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 healthy working relationships between community physicians, small provider practices, and WellCare • Educate providers on NCQA HEDIS measures, medical record documentation, and appropriate coding • Support provider practice sites and assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS standards • Collect, summarize, and trend provider performance data to identify provider improvement opportunities • Collaborate with Provider Relations on 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 agreed action plans • Document action plans, visit details, and outcomes • Report critical incidents and quality-of-care issues • Gather data from external sources to measure identified outcomes • Develop communications including newsletter articles, 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 contract and regulatory reports are accurate and submitted by deadlines • Enter findings into designated databases and ensure medical-record data accuracy • Perform other duties as assigned and comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Must have reliable transportation • Valid drivers' license • Must live in the Southeast Pennsylvania area • Willingness to travel up to 75% of the time • 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 that demonstrates the ability to perform the role • 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 that demonstrates the ability to learn and perform the level of the position • Preferred licenses/certifications include CCS, LPN, LMSW, LVN, LMHC, LMFT, LCSW, RN, APRN (ACNP-BC), foreign-trained physician/MD, HCQM, CHP, or CPHQ

🏖️ Benefits

• 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 • Equal opportunity employer committed to diversity