Centene Corporation
Pediatric RN- Quality Practice Advisor
Centene Corporation, Oakland, South Carolina, United States
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Pediatric RN- Quality Practice Advisor
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Centene Corporation This is a work-from-home, hybrid remote role (up to 50% travel) with provider groups based in South Carolina to discuss and improve HEDIS performance. Typical tasks include creating/exporting reports, PowerPoint presentations, and data analysis. Preference will be given to applicants who reside in South Carolina, have a pediatric background, and hold an active RN license. Position Details
Department: MED-Quality Improvement Business Unit: Absolute Total Care Schedule: Mon – Fri, 8am – 5 pm CT Territory: Typically no more than 2 hours from residence 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 opportunities for improvement and gap closure. Collaborates with Provider Relations and other provider-facing teams to improve provider performance in Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationships across product lines. Maintains Quality KPI and HEDIS Abstraction accuracy rates per corporate standards. Ability to travel up to 75% of the time to provider offices. Performs other duties as assigned. Complies with all policies and standards. Education/Experience
Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required Licenses/Certifications
One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS Registered Health Information Technician (RHIT®) Pay and Benefits
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 schedules. Actual pay will be adjusted based on skills, experience, education, and other job-related factors, including full-time or part-time status. Total compensation may include additional incentives. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer committed to diversity. 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 protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws. Job Attributes
Seniority level: Not Applicable Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care and Insurance
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Pediatric RN- Quality Practice Advisor
role at
Centene Corporation This is a work-from-home, hybrid remote role (up to 50% travel) with provider groups based in South Carolina to discuss and improve HEDIS performance. Typical tasks include creating/exporting reports, PowerPoint presentations, and data analysis. Preference will be given to applicants who reside in South Carolina, have a pediatric background, and hold an active RN license. Position Details
Department: MED-Quality Improvement Business Unit: Absolute Total Care Schedule: Mon – Fri, 8am – 5 pm CT Territory: Typically no more than 2 hours from residence 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 opportunities for improvement and gap closure. Collaborates with Provider Relations and other provider-facing teams to improve provider performance in Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationships across product lines. Maintains Quality KPI and HEDIS Abstraction accuracy rates per corporate standards. Ability to travel up to 75% of the time to provider offices. Performs other duties as assigned. Complies with all policies and standards. Education/Experience
Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required Licenses/Certifications
One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS Registered Health Information Technician (RHIT®) Pay and Benefits
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 schedules. Actual pay will be adjusted based on skills, experience, education, and other job-related factors, including full-time or part-time status. Total compensation may include additional incentives. Benefits may be subject to program eligibility. Equal Opportunity
Centene is an equal opportunity employer committed to diversity. 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 protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws. Job Attributes
Seniority level: Not Applicable Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care and Insurance
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