Associate Quality Practice Advisor

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Develop and maintain positive working relationships with community physicians, small provider practices, and WellCare.

• Educate providers and support practice sites on NCQA HEDIS measures.

• Provide training regarding HEDIS measures, medical record documentation, and proper coding.

• Assist in addressing deficiencies that impact compliance with State and Federal HEDIS standards.

• Collect, analyze, and summarize provider performance data to identify areas for improvement.

• Collaborate with Provider Relations to enhance Quality, Risk Adjustment, and Operations performance.

• Deliver metrics specific to providers and coach them on opportunities for gap closure.

• Identify the support needs of practices where WellCare can assist.

• Work alongside physicians and staff to promote member participation in wellness and education initiatives.

• Provide resources and educational opportunities for providers and their teams.

• Document concerns and issues in provider action plans.

• Record action plans, visit details, and outcomes accurately.

• Report on critical incidents and quality-of-care concerns.

• Gather necessary data from external sources to assess outcomes.

• Create newsletters, member education materials, outreach interventions, and provider training resources.

• Support quality improvement and program studies related to HEDIS, including record requests, database maintenance, and provider encounter history research.

• Ensure documentation meets state regulations and the requirements of accrediting bodies.

• Verify the accuracy of regulatory report content and ensure timely submissions.

• Input findings into databases and maintain the accuracy of medical record data.

• Perform additional duties as assigned and adhere to policies and standards.

⛳️ Requirements

• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work, or a related field, or equivalent work experience in a managed care environment related to HEDIS record review, quality improvement, medical coding, or other applicable skills.

• 1+ years of experience in HEDIS medical record review or quality improvement, including data and chart reviews to provide consultation and education to providers and their staff, OR 2 years of medical coding or other relevant experience and skill set combinations.

• Strong experience in quality improvement, including presenting to and collaborating with providers.

• Familiarity with HEDIS measures, medical record documentation, and HEDIS ICD-9/10 CPT coding in compliance with NCQA requirements.

• Ability to collect, summarize, and analyze provider performance data.

• Capability to provide consultation and educational support to providers and their staff.

• Up to 50% travel may be required.

• Preferred: Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work, or a related field.

• Preferred certifications/licenses: CCS, LPN, LMSW, LVN, LMHC, LMFT, LCSW, RN, APRN (ACNP-BC), foreign-trained physician/MD, HCQM, CHP, or CPHQ.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in total compensation.