Quality Practice Advisor

🔥 0 minutes ago

🏄 California – Remote

🏄 California – 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 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 • Serve as a resource for health plan peers on HEDIS measures, medical record documentation, and coding • Support development and implementation of quality improvement interventions and provider-related audits • 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 or coach on provider improvement opportunities and gap closure • 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 • Perform other assigned duties • Comply with all policies and standards

🎯 Requirements

• 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 • Registered Health Information Technician (RHIT®): state requirements apply for positions aligned to a corporate line of business operating within a state-specific health plan • Ability to travel up to 75% of time to provider offices • For IL Health Plan only: Must reside in IL or within a reasonable driving distance to assigned providers • Knowledge of National Committee for Quality Assurance (NCQA) HEDIS measures, risk adjustment, medical record documentation, and ICD-9/10 CPT coding • For certain plans, license/certification requirements vary, including preferred, not required, or not required statuses

🏖️ 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 • Equal opportunity employment • Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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