Quality Practice Advisor
Position Purpose
Key Detail
s: Candidates must reside in Nevada, as this position requires occasional travel. One of the following active licenses or certifications is required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS. Preferred qualifications include provider experience, HEDIS knowledge, medical coding experience, quality improvement experience, and health plan experience.
- Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
- Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure.
- Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
- Identifies specific practice needs where Centene can provide support.
- Develops, enhances and maintains provider clinical relationship across product lines.
- Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards.
- Ability to travel up to 75% of time to provider offices.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience
Not included in the source posting: about the role, what you'll do, benefits.
Who can apply
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