SilverSummit Healthplan
Join to apply for the Provider Quality Liaison role at SilverSummit Healthplan.
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.
Schedule and Location Schedule:
Mon–Fri, 8am–5pm (no weekends/holidays)
Location:
Reno or Elko, NV (Northern NV)
Travel:
50–75%
Valid Driver’s License Required.
Responsibilities
Conduct on-site visits across rural Nevada.
Educate rural practices (many new to MCOs) on plan resources and support.
Primary point of contact for provider groups; maintain strong relationships with providers and internal teams.
Translate data into clear action steps to improve quality performance and close gaps in care.
Manage quality initiatives and key performance indicators such as HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists.
Refer and connect providers with existing resources to educate on appropriate HEDIS measures, documentation guidelines and Member Experience measures.
Provide ongoing support to providers for quality improvement via regular touch points and meetings.
Educate, support, and resolve provider practice sites issues around P4P (Pay for Performance), RxEffect, CAHPS, HOS, CTMs (Complaints to Medicare), Disenrollments, Appeals, and Grievances.
Collaborate with Provider Relations and other provider‑facing teams to improve provider performance in Quality (Clinical and Member Experience measures). Provide clear insight into provider group dynamics, identify areas of opportunity, build action plans and collaborate cross‑functionally to support quality performance.
Develop, enhance and maintain provider relationships across all product lines (Medicare, Medicaid, Ambetter). Support the development and implementation of quality improvement interventions in relation to Plan providers.
Conduct telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps.
Perform other duties as assigned.
Comply 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:
$19.04 - $32.35 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, 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.
#J-18808-Ljbffr
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.
Schedule and Location Schedule:
Mon–Fri, 8am–5pm (no weekends/holidays)
Location:
Reno or Elko, NV (Northern NV)
Travel:
50–75%
Valid Driver’s License Required.
Responsibilities
Conduct on-site visits across rural Nevada.
Educate rural practices (many new to MCOs) on plan resources and support.
Primary point of contact for provider groups; maintain strong relationships with providers and internal teams.
Translate data into clear action steps to improve quality performance and close gaps in care.
Manage quality initiatives and key performance indicators such as HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists.
Refer and connect providers with existing resources to educate on appropriate HEDIS measures, documentation guidelines and Member Experience measures.
Provide ongoing support to providers for quality improvement via regular touch points and meetings.
Educate, support, and resolve provider practice sites issues around P4P (Pay for Performance), RxEffect, CAHPS, HOS, CTMs (Complaints to Medicare), Disenrollments, Appeals, and Grievances.
Collaborate with Provider Relations and other provider‑facing teams to improve provider performance in Quality (Clinical and Member Experience measures). Provide clear insight into provider group dynamics, identify areas of opportunity, build action plans and collaborate cross‑functionally to support quality performance.
Develop, enhance and maintain provider relationships across all product lines (Medicare, Medicaid, Ambetter). Support the development and implementation of quality improvement interventions in relation to Plan providers.
Conduct telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps.
Perform other duties as assigned.
Comply 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:
$19.04 - $32.35 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, 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.
#J-18808-Ljbffr