Quality Practice Advisor

📋 Description

• • As a Quality Practice Advisor at Centene Corporation, you will play a pivotal role in transforming the health of communities by fostering strong, collaborative relationships between large physician practices, Independent Practice Associations (IPAs), and Centene. This hybrid position, requiring up to 75% travel to provider offices within Alabama, is designed for a dedicated professional who can act as a key educator and liaison, ensuring optimal quality of care and compliance with national standards.
• • Your primary responsibility will be to educate providers and support their practice sites on critical quality initiatives, including the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures and risk adjustment methodologies. This involves providing in-depth guidance on HEDIS measures, emphasizing the importance of appropriate medical record documentation, and ensuring accurate coding practices.
• • You will be instrumental in identifying and resolving deficiencies that impact plan compliance, helping providers meet stringent State and Federal standards for HEDIS and documentation. This proactive approach ensures that Centene and its provider network maintain the highest levels of quality and regulatory adherence.
• • Beyond direct provider education, you will serve as a vital resource for Centene's health plan peers, offering expert insights on HEDIS measures, best practices in medical record documentation, and appropriate coding strategies. Your knowledge will empower internal teams to better support provider performance.
• • A significant aspect of your role will involve supporting the development and implementation of quality improvement interventions and conducting audits in relation to plan providers. This includes collecting, summarizing, and trending provider quality and risk adjustment performance data to pinpoint areas for improvement and to coach providers on effective gap closure strategies.
• • You will collaborate closely with Centene's Provider Relations team and other provider-facing departments to drive improvements in provider performance across key areas such as Quality, Risk Adjustment, and Operations, including claims and encounter data.
• • A crucial part of your contribution will be identifying specific practice needs where Centene can offer targeted support, thereby strengthening the partnership and enhancing overall care delivery.
• • You will be responsible for developing, enhancing, and maintaining strong clinical relationships with providers across various product lines, ensuring a consistent and high-quality experience.
• • Maintaining Quality Key Performance Indicators (KPIs) and ensuring good standing with HEDIS Abstraction accuracy rates, as per corporate standards, will be a continuous focus of your work.
• • This role demands a high degree of autonomy and the ability to manage your schedule effectively, given the significant travel requirements. You will be expected to travel up to 75% of the time to visit provider offices, conduct assessments, and deliver training.
• • You will perform other duties as assigned, contributing to the broader goals of the Quality department and Centene Corporation.
• • Adherence to all company policies and standards is paramount, ensuring operational integrity and compliance.
• • This position offers a unique opportunity to make a tangible impact on healthcare quality, working with a leading national organization dedicated to transforming the health of its members and communities.