Quality Practice Advisor

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

📋 Description

• Build and nurture collaborative relationships with large physician practices, IPAs, and Centene.

• Educate providers and assist practice sites in understanding NCQA HEDIS measures and risk adjustment.

• Offer training on HEDIS measures, medical record documentation, and coding requirements.

• Aid in addressing deficiencies that impact compliance with state and federal HEDIS and documentation standards.

• Act as a resource for peers within the health plan.

• Support the creation and execution of quality improvement initiatives and provider-related audits.

• Provide guidance and education to provider practices and IPAs on HEDIS measures, documentation requirements, and HEDIS ICD-9/10 CPT coding.

• Gather, analyze, trend, and present provider quality and risk adjustment performance data.

• Identify and formulate strategies for provider improvement and gap closure opportunities.

• Collaborate with Provider Relations and other teams that interact with providers.

• Recognize practice needs where Centene can offer assistance.

• Develop, strengthen, and sustain clinical relationships with providers across various product lines.

• Ensure Quality KPIs and maintain HEDIS abstraction accuracy standards.

• Adhere to all policies and standards.

• Carry out additional duties as assigned.

⛳️ Requirements

• Candidates must be residents of Nevada.

• A Bachelor's Degree or equivalent is required.

• A minimum of 3 years of experience in HEDIS record collection and risk adjustment (coding) is required.

• One active license or certification is required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A, or CBCS.

• Willingness to travel up to 75% of the time to provider offices.

• Familiarity with HEDIS measures, medical record documentation, and appropriate coding practices.

• Preferred qualifications include provider experience, knowledge of HEDIS, medical coding experience, quality improvement experience, and experience with health plans.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Additional incentives may be included in the overall compensation package.