Centene Corporation
Pediatric RN- Quality Practice Advisor
Centene Corporation, Ladys Island, South Carolina, United States, 29907
Pediatric RN- Quality Practice Advisor
Centene Corporation
This role allows you to make a difference for our 28 million members. As a diversified national organization, you’ll have access to competitive benefits and a fresh perspective on workplace flexibility.
Work‑from‑home, hybrid remote (up to 50% travel) role that meets virtually and in person with provider groups based in South Carolina. Typical daily tasks include creating and exporting PowerPoint presentations, reports, and data analysis. Preference is given to applicants who live in South Carolina, have a pediatric background, and hold an active RN license.
Department and Schedule
Department: MED‑Quality Improvement
Business Unit: Absolute Total Care
Schedule: Mon – Fri, 8 am – 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 NCQA HEDIS measures and risk adjustment. Provides education on HEDIS measures, medical‑record documentation, and coding. Assists in resolving deficiencies impacting plan compliance to meet state and federal standards. Act as a resource for health‑plan peers on HEDIS measures, documentation and coding. Supports the development and implementation of quality improvement interventions and audits.
Responsibilities
Deliver, advise and educate provider practices and IPAs on appropriate HEDIS measures, medical‑record documentation guidelines, and HEDIS ICD‑9/10 CPT coding according to state, federal and NCQA requirements.
Collect, summarize, trend, and deliver provider quality and risk‑adjustment performance data to identify and coach on 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 (claims and encounters).
Identify specific practice needs where Centene can provide support.
Develop, enhance and maintain provider clinical relationships across product lines.
Maintain quality KPIs and uphold HEDIS abstraction accuracy rates per corporate standards.
Travel up to 75 % of time to provider offices.
Perform other duties as assigned.
Comply with all policies and standards.
Education and Experience
Bachelor’s Degree or equivalent required.
3+ years in HEDIS record collection and risk adjustment (coding) required.
Licenses and 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®).
Compensation and Benefits
Pay range: $26.50 – $47.59 per hour.
Benefits include health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work options.
Actual pay adjusted based on skills, experience, education and other factors.
Additional incentives may be included.
EEO Statement 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 any other protected characteristic. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Referral Program Referrals increase your chances of interviewing at Centene Corporation by 2×.
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This role allows you to make a difference for our 28 million members. As a diversified national organization, you’ll have access to competitive benefits and a fresh perspective on workplace flexibility.
Work‑from‑home, hybrid remote (up to 50% travel) role that meets virtually and in person with provider groups based in South Carolina. Typical daily tasks include creating and exporting PowerPoint presentations, reports, and data analysis. Preference is given to applicants who live in South Carolina, have a pediatric background, and hold an active RN license.
Department and Schedule
Department: MED‑Quality Improvement
Business Unit: Absolute Total Care
Schedule: Mon – Fri, 8 am – 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 NCQA HEDIS measures and risk adjustment. Provides education on HEDIS measures, medical‑record documentation, and coding. Assists in resolving deficiencies impacting plan compliance to meet state and federal standards. Act as a resource for health‑plan peers on HEDIS measures, documentation and coding. Supports the development and implementation of quality improvement interventions and audits.
Responsibilities
Deliver, advise and educate provider practices and IPAs on appropriate HEDIS measures, medical‑record documentation guidelines, and HEDIS ICD‑9/10 CPT coding according to state, federal and NCQA requirements.
Collect, summarize, trend, and deliver provider quality and risk‑adjustment performance data to identify and coach on 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 (claims and encounters).
Identify specific practice needs where Centene can provide support.
Develop, enhance and maintain provider clinical relationships across product lines.
Maintain quality KPIs and uphold HEDIS abstraction accuracy rates per corporate standards.
Travel up to 75 % of time to provider offices.
Perform other duties as assigned.
Comply with all policies and standards.
Education and Experience
Bachelor’s Degree or equivalent required.
3+ years in HEDIS record collection and risk adjustment (coding) required.
Licenses and 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®).
Compensation and Benefits
Pay range: $26.50 – $47.59 per hour.
Benefits include health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work options.
Actual pay adjusted based on skills, experience, education and other factors.
Additional incentives may be included.
EEO Statement 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 any other protected characteristic. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Referral Program Referrals increase your chances of interviewing at Centene Corporation by 2×.
#J-18808-Ljbffr