Associate Quality Practice Advisor
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Job Description
Associate Quality Practice Advisor educating Michigan providers on HEDIS measures, coding, documentation and quality improvement. Supporting Centene’s healthcare-access mission through data analysis and practice coaching.
Responsibilities:
- Establish and foster healthy working relationships between community physicians, small provider practices and WellCare
- Educate providers and support provider practice sites regarding NCQA HEDIS measures
- Provide education on HEDIS measures, medical record documentation and appropriate coding
- Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS standards
- Collect, summarize and trend provider performance data to identify improvement opportunities
- Collaborate with Provider Relations to improve Quality, Risk Adjustment and Operations performance
- Deliver provider-specific metrics and coach providers on gap-closing opportunities
- Identify practice needs where WellCare can provide support
- Partner with physicians and staff to encourage member clinical participation in wellness and education
- Provide resources and educational opportunities to providers and staff
- Capture concerns and issues in provider action plans
- Document action plans, visit details and outcomes
- Report critical incidents and quality-of-care issues
- Gather data from external sources as needed to measure outcomes
- Create newsletters, member education, outreach interventions and provider education
- Support HEDIS quality-improvement and program studies, including requesting records, maintaining databases and researching provider encounter history
- Ensure documentation complies with state regulations and accrediting-body requirements
- Ensure regulatory report content is accurate and submitted by deadlines
- Enter findings into databases and ensure medical-record data accuracy
- Perform other duties as assigned and comply with policies and standards
Requirements:
- Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field, or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets
- 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff, OR 2 years medical coding or other transferable experience and skill set combination
- Strong quality experience, including presenting to and partnering with providers
- Knowledge of HEDIS measures, medical record documentation and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements
- Ability to collect, summarize and trend provider performance data
- Ability to provide consultation and education to providers and provider staff
- Up to 50% travel required
- Preferred: Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field
- Preferred license/certification: CCS, LPN, LMSW, LVN, LMHC, LMFT, LCSW, RN, APRN (ACNP-BC), foreign-trained physician/MD, HCQM, CHP or CPHQ
Benefits:
- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
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