Pediatric RN- Quality Practice Advisor

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.

• NOTE : This is a work-from-home, hybrid remote (up to 50% travel) role that meets virtually and in person with provider groups based in South Carolina to discuss and improve HEDIS performance. Typical daily tasks will include creating / using PowerPoint presentations, creating / exporting reports, and data analysis. Preference will be given to applicants who (1) reside in South Carolina, (2) have a pediatric background, and (3) an active RN license.

Additional Details :

Position Purpose :

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.

Education / Experience :

Bachelor's Degree or equivalent required

3+ years in HEDIS record collection and risk adjustment (coding) required

Licenses / 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®)

Pay Range : $26.50 - $47.59 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.