Managed Health Services (MHS)
Quality Practice Advisor Behavioral Health
Managed Health Services (MHS), Indiana, Pennsylvania, us, 15705
Quality Practice Advisor Behavioral Health
Managed Health Services (MHS) – Indiana
Opportunity to make a difference for 28 million members as part of Centene’s national organization. Competitive benefits with flexibility.
Position Purpose
Establish and foster healthy working relationships between large physician practices, IPAs, and Centene.
Educate providers and support provider practice sites regarding NCQA HEDIS measures, risk adjustment, and appropriate medical record documentation and coding.
Assist in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards.
Act as a resource for health plan peers on HEDIS measures, medical record documentation and coding.
Support the development and implementation of quality improvement interventions and audits in relation to plan providers.
Key Responsibilities
Deliver, advise, and educate provider practices and IPAs on HEDIS measures, documentation guidelines, and HEDIS ICD‑9/10 CPT coding.
Collect, summarize, trend, and deliver provider quality and risk adjustment performance data; coach and strategize opportunities for improvement and gap closure.
Collaborate with Provider Relations and other provider‑facing teams to improve provider performance in Quality, Risk Adjustment, and Operations.
Identify specific practice needs where Centene can provide support.
Develop, enhance, and maintain provider clinical relationships across product lines.
Maintain Quality KPIs and HEDIS abstraction accuracy rates per corporate standards.
Travel up to 50% of time to provider offices; candidate must reside in the state of Indiana.
Perform other duties as assigned; comply 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
Must hold one of the following: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC‑A or CBCS.
For Managed Health Services – IN: no license/certification is required.
Compensation
Pay Range: $26.50 – $47.59 per hour.
Benefits
Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work options (remote, hybrid, field, office).
EEO Statement Centene is an equal‑opportunity employer committed to diversity. All qualified applicants receive consideration 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 the LA County Ordinance and the California Fair Chance Act.
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Opportunity to make a difference for 28 million members as part of Centene’s national organization. Competitive benefits with flexibility.
Position Purpose
Establish and foster healthy working relationships between large physician practices, IPAs, and Centene.
Educate providers and support provider practice sites regarding NCQA HEDIS measures, risk adjustment, and appropriate medical record documentation and coding.
Assist in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards.
Act as a resource for health plan peers on HEDIS measures, medical record documentation and coding.
Support the development and implementation of quality improvement interventions and audits in relation to plan providers.
Key Responsibilities
Deliver, advise, and educate provider practices and IPAs on HEDIS measures, documentation guidelines, and HEDIS ICD‑9/10 CPT coding.
Collect, summarize, trend, and deliver provider quality and risk adjustment performance data; coach and strategize opportunities for improvement and gap closure.
Collaborate with Provider Relations and other provider‑facing teams to improve provider performance in Quality, Risk Adjustment, and Operations.
Identify specific practice needs where Centene can provide support.
Develop, enhance, and maintain provider clinical relationships across product lines.
Maintain Quality KPIs and HEDIS abstraction accuracy rates per corporate standards.
Travel up to 50% of time to provider offices; candidate must reside in the state of Indiana.
Perform other duties as assigned; comply 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
Must hold one of the following: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC‑A or CBCS.
For Managed Health Services – IN: no license/certification is required.
Compensation
Pay Range: $26.50 – $47.59 per hour.
Benefits
Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work options (remote, hybrid, field, office).
EEO Statement Centene is an equal‑opportunity employer committed to diversity. All qualified applicants receive consideration 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 the LA County Ordinance and the California Fair Chance Act.
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