Provider Quality Liaison at Centene Corporation

, Wisconsin, United States -

Full Time

Start Date

Immediate

Expiry Date

23 May, 26

Salary

32.98

Posted On

22 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Healthcare Experience, Provider Relations, Communication Skills, Data Interpretation, Organization, Independence, Detail-Oriented, Priority Management, HEDIS, CAHPS, HOS, Part D Reporting, Quality Improvement, Provider Education, Action Planning, Relationship Management

Industry

Hospitals and Health Care

Description

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. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Candidates must reside in Wisconsin and be able to travel up to 30%, including in‑person provider visits in Waukesha, Dane, and Milwaukee counties, along with virtual and telephonic engagement. The ideal candidate will have healthcare experience, preferably working with providers and community partners, strong communication skills, the ability to interpret data, and be organized, independent, detail‑oriented, and able to manage multiple priorities and deadlines. A valid driver’s license is required. LPN or LVN licensure preferred. Position Purpose: Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators. Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers. Use existing resources to collaborate with provider offices and internal partners on performance measure barriers, actions to mitigate low performing measures, and the sharing of quality best practices to support providers. References and connects providers with existing resources to educate provider practices in appropriate HEDIS (Healthcare Effectiveness Data and Information Set) measures, medical record documentation guidelines and Member Experience measures. Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings. Educates, supports, and resolves provider practice sites issues around P4P (Pay for Performance), RxEffect, CAHPS (Consumer Assessment of Healthcare Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollment's, Appeals, and Grievances. Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures). Provides clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance. Develops, enhances and maintains provider relationship across all product lines (Medicare, Medicaid, Ambetter). Supports the development and implementation of quality improvement interventions in relation to Plan providers Conducts telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps. Performs other duties as assigned. Complies 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: $19.43 - $32.98 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 Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email recruiting@centene.com. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.

Responsibilities

The role is responsible for connecting with plan providers regarding quality initiatives and key performance indicators, sharing various quality and performance reports, and collaborating on performance barriers and best practices. This includes acting as an ongoing resource for quality improvement, educating practices on documentation guidelines, and resolving issues related to Pay for Performance and member experience measures.