Associate Quality Practice Advisor

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

📋 Description

• Build and maintain positive working relationships among community physicians, small provider practices, and WellCare.

• Inform providers about NCQA HEDIS measures, medical record documentation, and correct coding practices.

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

• Gather, analyze, and trend provider performance data to pinpoint opportunities for improvement.

• Work collaboratively with Provider Relations on Quality, Risk Adjustment, and Operations performance metrics.

• Present provider-specific metrics and guide providers on opportunities to close gaps.

• Recognize practice needs where WellCare can offer support.

• Collaborate with physicians and staff to promote member participation in wellness and education initiatives.

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

• Document concerns and issues within agreed-upon action plans.

• Maintain records of action plans, visit details, and outcomes.

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

• Collect data from external sources to assess identified outcomes.

• Create communications, including newsletter articles, member education materials, outreach initiatives, and provider education content.

• Support HEDIS quality improvement and program studies, which involve record requests, database maintenance, and provider encounter history research.

• Ensure documentation adheres to state regulations and accrediting body standards.

• Verify that contract and regulatory reports are accurate and submitted by the required deadlines.

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

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

⛳️ Requirements

• Must be authorized to work in the U.S. without requiring employment-based visa sponsorship, now or in the future.

• Must possess reliable transportation.

• A valid driver's license is required.

• Must reside in the Southeast Pennsylvania area.

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

• 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 transferable skill sets demonstrating the ability to perform the role.

• At least 1 year of experience in HEDIS medical record review or quality improvement, with skills in data and chart reviews to provide consultation and education to providers and their staff, or 2 years of medical coding or other transferable experience that demonstrates the ability to learn and perform the responsibilities of the position.

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

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Additional incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.