Quality Practice Advisor - Medical Affairs

Centene Corporation • Houston, TX • 2d ago

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Applicants with HEDIS measures and Medicare STAR Ratings experience

Work Location: Houston, TX/Harris County, TX or must be able to relocate to Houston, TX

TRAVEL IS REQUIRED - 3 DAYS - Meetings are IN-PERSON with Providers

Work From Home: 2 days per week

Monday - Friday: 800 am - 500 pm (CST)

Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers.

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

Education/Experience: Bachelor's Degree or equivalent required AND 3+ years in HEDIS record collection and risk adjustment required.

One of the following required: RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS, CCS, LPN, LVN, LMSW, LMFT, LPC, LCSW

Preferred Experience:

Extensive clinical skills in nursing, nursing informatics, medicine, public health, or healthcare administration that focuses on closing health care gaps for patients

3+ years of working directly with HEDIS measure, Medicare STAR ratings, and Risk Adjustment knowledge - 90% of role responsibilities

Experience in medicine or clinical provider role (RN, APRN, PA, or Medical Doctor graduate education) utilizing clinical knowledge and skills in an advisory/consultative role

Experience training and educating physicians, nurses, and clinical staff on HEDIS measures

Data Analysis skills - interpreting statistical data, assessing performance, and making recommendation in areas of improvement

Strategic Advisor/Consultative skills, Emotional Intelligence, Communication/Public Speaking, Coaching/Training, Time Management, and Organizational skills are critical in this role

Proficient computer skills utilizing Microsoft Office applications (Excel, Outlook, Power Point, etc) and be comfortable learning new skills (i.e data collection, extraction, auditing reports) and able to navigate between multiple databases

Experience utilizing multiple avenues of communication (i.e. Physician meetings - IN PERSON, Email, Phone, Video Conferencing Applications)

Experience and working knowledge with Medicare, Medicaid and Marketplace insurance practices and regulations is preferred

Pay Range: $26.50 - $47.59 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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