Provider Quality Liaison
Company: Centene Medicare
Posted on: November 18, 2023
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.
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
- 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), Disenrollments, 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
- 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.Education/Experience: High
school diploma or GED or equivalent experience. Associate's degree
preferred. 2+ years of experience with clinical and member
experience quality. Intermediate knowledge of Excel, Word, and
License/Certification: Driver's License required. Pharmacy
Technician, Medical Assistant Licensed Vocational Nurse, Licensed
Practical Nurse, Social Work licensure preferred.
Our Comprehensive Benefits Package: Flexible work solutions
including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development.
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.
Keywords: Centene Medicare, Beaverton , Provider Quality Liaison, Other , Beaverton, Oregon
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