Job description
Position Purpose:
Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators. Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers. Use existing resources to collaborate with provider offices and internal partners on performance measure barriers, actions to mitigate low performing measures, and the sharing of quality best practices to support providers.
Key Details: Candidates must reside in Nevada, with preference given to those located in Northern Nevada. The ideal candidate will be willing to travel as needed and possess experience in HEDIS, provider engagement, and healthcare quality improvement initiatives
References and connects providers with existing resources to educate provider practices in appropriate HEDIS (Healthcare Effectiveness Data and Information Set) measures, medical record documentation guidelines and Member Experience measures.
Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings.
Educates, supports, and resolves provider practice sites issues around P4P (Pay for Performance), RxEffect, CAHPS (Consumer Assessment of Healthcare Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollments, Appeals, and Grievances.
Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures). Provides clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance.
Develops, enhances and maintains provider relationship across all product lines (Medicare, Medicaid, Ambetter). Supports the development and implementation of quality improvement interventions in relation to Plan providers
Conducts telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps.
Performs other duties as assigned.
Complies with all policies and standards
Education/Experience:
High school diploma or equivalent. Associate’s degree preferred. 2+ years of experience with clinical and member experience quality.
License/Certification: Driver’s License required. Pharmacy Technician, Medical Assistant Licensed Vocational Nurse, Licensed Practical Nurse, Social Work licensure preferred.
Pay Range: $19.43 - $32.98 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.