Full-Time

Associate Quality Practice Advisor

Posted on 1/11/2025

Centene

Centene

10,001+ employees

Provides health insurance and services

Compensation Overview

$25.97 - $46.68Hourly

Entry, Junior

Remote in USA

Category
Healthcare Administration & Support
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Requirements
  • A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role.
  • 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff OR 2 years medical coding or other transferable experience and skill set combination that demonstrates the ability to learn and perform the level of the position.
Responsibilities
  • Educates community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements.
  • Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement.
  • Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters).
  • Assists in delivering provider specific metrics and coaches providers on gap closing opportunities.
  • Assists in identifying specific practice needs where WellCare can provide support.
  • Partners with physicians/physician staff to find ways to encourage member clinical participation in wellness and education.
  • Provides resources and educational opportunities to provider and staff.
  • Captures concerns and issues in action plans as agreed upon with provider.
  • Documents action plans and details of visits and outcomes. Reports critical incidents and information regarding quality of care issues.
  • Communicates with external data sources as needed to gather data necessary to measure identified outcomes.
  • Provides communication such as newsletter articles, member education, outreach interventions and provider education.
  • Supports quality improvement HEDIS and program studies as needed, requesting records from providers, maintaining databases, and researching to identify members' provider encounter history.
  • Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
  • Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.
  • Enter documentation of findings in identified databases and ensure accuracy in medical records for data collection, DE and reporting.
Desired Qualifications
  • A Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field.
  • A license in one of the following is preferred: Certified Coding Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Licensed Vocational Nurse (LVN), Licensed Mental Health Counselor (LMHC), Licensed Marital and Family Therapist (LMFT), Licensed Certified Social Worker (LCSW), Licensed Registered Nurse (RN), Acute Care Nurse Practitioner (APRN) (ACNP-BC), Other Foreign trained physician/MD, Health Care Quality and Management (HCQM), Certified Healthcare Professional (CHP), Certified Professional in Healthcare Quality (CPHQ).

Centene Corporation operates in the healthcare industry, focusing on providing health insurance and services to individuals, particularly those who are underinsured or uninsured. The company offers a variety of health insurance products, including medical, dental, vision, and behavioral health services, as well as pharmacy benefits. Centene's business model emphasizes a localized approach, allowing it to tailor its services to meet the specific needs of different communities across the United States. This strategy sets Centene apart from competitors by ensuring that care is relevant and accessible to its members. The company generates revenue primarily through premiums collected from its 27.5 million members, amounting to $140.1 billion in 2023. Centene's goal is to improve health outcomes while managing costs, and it is committed to corporate sustainability, addressing social barriers to health, and supporting employee well-being through flexible work arrangements.

Company Size

10,001+

Company Stage

IPO

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Telehealth expansion offers Centene a growing market for remote healthcare solutions.
  • Value-based care models align with Centene's cost-effective healthcare delivery strategy.
  • Addressing social determinants of health enhances Centene's community health initiatives.

What critics are saying

  • Cybersecurity vulnerabilities could impact Centene's reputation and financial stability.
  • The Bowen Homes project may face financial risks from potential delays or cost overruns.
  • Investor pressure for short-term gains may affect Centene's long-term strategic goals.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company focuses on underinsured and uninsured individuals, a unique market segment.
  • Centene integrates medical, dental, vision, and behavioral health services for comprehensive care.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours

Company News

BioSpace
Mar 8th, 2025
CENTENE TO PRESENT AT BARCLAYS 27TH ANNUAL GLOBAL HEALTHCARE CONFERENCE

ST. LOUIS, March 7, 2025 /PRNewswire/ - Centene Corporation (NYSE: CNC), a leading healthcare enterprise committed to helping people live healthier lives, announced today it will present via webcast at the Barclays 27th Annual Global Healthcare Conference on Wednesday, March 12, 2025, at 2:30 p.m. EDT.

PR Newswire
Mar 7th, 2025
Centene To Present At Barclays 27Th Annual Global Healthcare Conference

ST. LOUIS, March 7, 2025 /PRNewswire/ -- Centene Corporation (NYSE: CNC), a leading healthcare enterprise committed to helping people live healthier lives, announced today it will present via webcast at the Barclays 27th Annual Global Healthcare Conference on Wednesday, March 12, 2025, at 2:30 p.m. EDT. The live webcast will be available here: Centene's Presentation.A webcast replay will be available following the presentation on Centene's website, www.centene.com, under the Investors section.About Centene CorporationCentene Corporation , a Fortune 500 company, is a leading healthcare enterprise that is committed to helping people live healthier lives. The Company takes a local approach – with local brands and local teams – to provide fully integrated, high-quality and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene offers affordable and high-quality products to more than 1 in 15 individuals across the nation, including Medicaid and Medicare members (including Medicare Prescription Drug Plans) as well as individuals and families served by the Health Insurance Marketplace.Centene uses its investor relations website to publish important information about the Company, including information that may be deemed material to investors

PR Newswire
Mar 5th, 2025
Peach State Health Plan And Centene Foundation Announce Investment In Atlanta Housing Development At Groundbreaking Ceremony

The collaboration will renew the Bowen Homes community to provide access to quality housing, healthcare and community resourcesATLANTA, March 5, 2025 /PRNewswire/ – Peach State Health Plan, a care management organization serving Georgians, and the Centene Foundation, the philanthropic arm of Centene Corporation (NYSE: CNC), today joined Atlanta Housing ("AH") and the City of Atlanta to break ground on the redevelopment of the Bowen Homes community in Atlanta, Georgia. Peach State Health Plan and the Foundation's investment will support efforts by McCormack Baron Salazar (MBS) to build a community designed to address health disparities and advance community health in the city.The Centene Foundation's funding contribution is the first state-level deployment of the Foundation's partnership with MBS, as announced in 2024. Below market-rate loans support predevelopment design, planning work and local community engagement while unlocking additional financing needed to accelerate projects."Peach State Health Plan is committed to addressing drivers of health – and that starts with ensuring all Georgians have access to both quality housing and healthcare," said Clyde A. White, President of Peach State Health Plan. "Through our continued investment in Bowen Homes, we are creating real opportunities for families to thrive in a neighborhood designed with health, empowerment and resilience at its core."The plan for the site will be community-focused with more than 750 residential units, and recreational amenities including outdoor plazas, seating, walking trails and more, along the Donald Lee Hollowell Parkway and James Jackson Parkway corridors in the Carey Park neighborhood."By combining affordable housing, nutrition education, and behavioral and physical health resources, we can actively improve the quality of life for Georgians," said Centene Foundation President Keith Williamson. "Centene Foundation's partnership with MBS allows us to address healthcare challenges head on – increasing healthcare access, closing long-term health disparities and improving health outcomes."The Centene Foundation and Peach State Health Plan's commitment in the Bowen Homes project builds on its broader investments in creating positive local impact and commitment to fostering long-term health by actively working with the community to shape approaches, connecting residents to essential healthcare and social services, and addressing community needs and vital resources, such as education opportunities for nutrition, behavioral health and maternal care

PR Newswire
Mar 4th, 2025
Superior Healthplan To Provide $200,000 Through Annual Grant Program

Community-based organizations and providers across Texas can apply for funding through March 31, 2025.AUSTIN, Texas, March 4, 2025 /PRNewswire/ -- Superior HealthPlan ("Superior"), a leading managed care organization in Texas and a company of Centene Corporation (NYSE: CNC), is accepting applications for its annual grant program, open to community-based organizations and providers in Texas. The funding is targeted to address non-medical drivers of health, also known as social determinants of health, to meet the needs of low-income neighborhoods throughout the state."We are pleased to continue the Superior HealthPlan grant program that will support organizations and providers in Texas that make a difference in our communities," said Superior HealthPlan President and CEO, Mark Sanders. "Superior has provided these community grants for years and is looking forward to continuing this important program."Since 2020, Superior has provided more than $740,000 in funding to community partners and providers through its grant program, which addresses barriers to health and wellness, such as access to food, economic stability, housing, education, and other critical needs.In 2025, ten community-based organizations and ten providers will be selected to receive one of these grants, each receiving $10,000 in funding, for a total of $200,000. The funding will be made available in April.To apply, organizations and providers must meet the following criteria:Grant recipients must serve the Medicaid population.Recipients must allow an end-of-term follow-up visit by December 15 to show funding outcomes.to show funding outcomes. Funds cannot cover staff salaries or benefits.Recipients must be based in Texas and serve Texas residents.and serve residents. All required documents (signed agreement, W-9, vendor forms, etc.) must be submitted by April 30, 2025 .Applications are due by March 31, 2025

PR Newswire
Feb 24th, 2025
CENTENE APPOINTS KENNETH Y. TANJI TO BOARD OF DIRECTORS

Centene appoints Kenneth Y. Tanji to Board of Directors.

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