Associate Quality Practice Advisor

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

📋 Description

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

• Provide education to providers and practice sites about NCQA HEDIS measures.

• Offer training on HEDIS measures, medical record documentation, and the correct use of ICD-9/10 CPT coding.

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

• Gather, summarize, and analyze provider performance data to highlight areas for improvement.

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

• Present provider-specific metrics and mentor providers on opportunities for gap closure.

• Identify the needs of practices where WellCare can offer assistance.

• Collaborate with physicians and their teams to boost member engagement in wellness and educational initiatives.

• Provide resources and learning opportunities for providers and their staff.

• Document concerns and issues in provider action plans; record visit details and outcomes.

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

• Communicate with external data sources to obtain necessary data for measuring outcomes.

• Develop newsletters, member education materials, outreach initiatives, and provider training.

• Assist with HEDIS quality improvement and program studies, including record requests, database maintenance, and research of provider encounter history.

• Ensure documentation adheres to state regulations and requirements set by accrediting bodies.

• Verify that regulatory report content is accurate and submitted on time.

• Input findings into databases and ensure medical records are accurate for data collection, DE, and reporting.

• Carry out other assigned tasks and comply with policies and standards.

⛳️ Requirements

• Must reside in the Central Pennsylvania region.

• Willingness to travel up to 75% of the time is required.

• Reliable transportation is necessary.

• A valid driver’s license is required.

• A bachelor’s degree in healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work, or a related field, or equivalent experience in a managed care environment related to HEDIS record review, quality improvement, medical coding, or applicable transferable skills.

• A minimum of 1 year of relevant 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.

• A master’s degree in a related field is preferred.

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

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

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

• Skill in educating and coaching providers and their staff.

• Capability to maintain databases and investigate provider encounter history.

• Ability to ensure compliance with regulatory and accrediting body standards.

• Competence in producing accurate reports and adhering to submission deadlines.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K and stock purchase options.

• Tuition reimbursement program.

• Paid time off along with holidays.

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

• Additional incentive options may be included in total compensation.

• Equal opportunity employer dedicated to diversity.