Iowa Total Care ยท 1 day ago
Quality Practice Advisor
Omaha, NE
Full-time
Hybrid
Mid Level
$27.02/hr - $48.55/hr
3+ years expIowa Total Care is part of Centene, a national organization focused on transforming the health of communities. The Quality Practice Advisor role involves educating providers on HEDIS measures and supporting compliance with documentation standards, while also fostering relationships with physician practices and IPAs.
Hospital & Health Care
Responsibilities
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 and strategize/coach on opportunities for provider improvement and gap closure
Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters)
Identifies specific practice needs where Centene can provide support
Develops, enhances and maintains provider clinical relationship across product lines
Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards
Ability to travel up to 75% of time to provider offices
Performs other duties as assigned
Complies with all policies and standards
Qualification
Required
Bachelor's Degree or equivalent required
3+ years in HEDIS record collection and risk adjustment (coding) required
One of the following required CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS
Ability to travel up to 75% of time to provider offices
Preferred
An Iowa nursing license is strongly preferred
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
Iowa Total Care
Iowa Total Care is a Managed Care Organization (MCO) health plan contracted with the Iowa Department of Health and Human Services (Iowa HHS) to serve Medicaid members enrolled in Iowa Health Link, the Iowa Health and Wellness Plan (IHAWP), and Healthy and Well Kids in Iowa (Hawki).
501-1000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase