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Quality Practice Advisor

  • Job
    Full-time
    Mid Level
  • Consulting
    Healthcare
  • West Palm Beach

AI generated summary

  • You must reside in Florida, have a bachelor’s degree, 3+ years in HEDIS record collection/risk adjustment, a driver’s license, and a clinical license (CCS, LPN, RN, etc.).
  • You will educate providers on HEDIS measures, analyze performance data, collaborate with teams for improvement, maintain clinical relationships, and ensure compliance with quality standards while traveling frequently.

Requirements

  • Qualified Candidates must reside in Florida
  • Bachelor’s degree or equivalent required
  • 3+ years of experience in HEDIS record collection and risk adjustment (coding)
  • Drivers license and one of the following clinical licensure is required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS

Responsibilities

  • 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.

FAQs

What is the role of a Quality Practice Advisor at Centene?

The Quality Practice Advisor establishes and fosters relationships between large physician practices, IPAs, and Centene, educating providers on HEDIS measures, risk adjustment, and documentation standards.

What qualifications are required for this position?

A Bachelor’s degree or equivalent and at least 3 years of experience in HEDIS record collection and risk adjustment coding are required.

Is clinical licensure mandatory for this role?

Yes, a clinical licensure such as CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, or CBCS is required.

How often will I need to travel for this job?

The position requires travel up to 75% of the time to provider offices.

What are the primary duties of a Quality Practice Advisor?

The primary duties include educating provider practices on HEDIS measures, summarizing provider quality performance data, collaborating with Provider Relations, and supporting quality improvement interventions.

What benefits does Centene offer to its employees?

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work schedules.

Is this position remote or in-office?

The position offers a flexible approach to work, including remote, hybrid, field, or office work schedules.

Where must qualified candidates reside?

Qualified candidates must reside in Florida.

What is the pay range for the Quality Practice Advisor position?

The pay range is $25.97 to $46.68 per hour, adjusted based on skills, experience, education, and other job-related factors.

What commitment does Centene have regarding diversity and equal opportunity?

Centene is an equal opportunity employer that is committed to diversity and values the unique differences of all applicants, ensuring that all qualified candidates receive consideration for employment.

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Human Resources
Industry
51-200
Employees
2011
Founded Year

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