Associate Quality Practice Advisor

Job not on LinkedIn

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 practice sites regarding NCQA HEDIS measures • Provide education on HEDIS measures, medical record documentation, and appropriate ICD-9/10 CPT 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 participation in wellness and education • Provide resources and educational opportunities to providers and staff • Capture concerns and issues in provider action plans; document visits and outcomes • Report critical incidents and quality-of-care issues • Communicate with external data sources to gather data 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 accuracy for data collection, DE, and reporting • Perform other assigned duties and comply with policies and standards

🎯 Requirements

• Must live in the Central Pennsylvania area • Must be willing to travel up to 75% of the time • Must have reliable transportation • Must have a valid driver’s license • 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 • At least 1 year of related HEDIS medical record review or quality-improvement experience, including data and chart reviews for provider consultation and education, OR 2 years of medical coding or other transferable experience and skill combination • Preferred master’s degree in a related field • Preferred license or credential such as CCS, LPN, LMSW, LVN, LMHC, LMFT, LCSW, RN, ACNP-BC/APRN, foreign-trained physician/MD, HCQM, CHP, or CPHQ • Knowledge of HEDIS measures, NCQA requirements, medical-record documentation, and ICD-9/10 CPT coding • Ability to collect, summarize, trend, and analyze provider performance data • Ability to educate and coach providers and provider staff • Ability to maintain databases and research provider encounter history • Ability to ensure regulatory and accrediting-body compliance • Ability to produce accurate reports and meet submission deadlines

🏖️ Benefits

• 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 • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity