Organize and assemble various quality indicators which are reported to the Quality Management Risk Management Committee. Coordinate Quality of Care (QOC) tracking process and the operational department reporting to ensure timely submission to the payors.
- Serves as the Quality Improvement STARS subject matter expert between provider groups and the Plan in coordination with key provider engagement partners.
- Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings. This includes attendance and participation at provider joint operating committee meetings.
- Collects, summarizes, and delivers provider quality performance data to strategize/coach on opportunities for provider improvement and gap closure. Educates provider practices on appropriate HEDIS measures, medical record documentation guidelines, and HEDIS ICD-10 CPT coding in accordance with State, Federal, and NCQA requirements.
- In conjunction with Pharmacy leads, provides support around medication adherence with providers. Drives adoption and usage of key pharmacy adherence provider tools.
- Supports the development and implementation of quality improvement intervention in relation to Plan providers
- Prepare Quality Improvement (QI) reports and submit for review prior to submission.
- Track incident, accident, and death (IAD) reports and correspond to QOC investigations to ensure resolution meets the timeliness standards and ensure appropriate information is provided the payor.
- Organize and assemble IAD and QOC data for the QM Committee, the Credentialing Committee, and other entities.
- Ensure that all departments submit reports timely to the payors.
- Participate in the Risk Committee or other appropriate committees as designated.
- Conduct audits of the State IAD-QOC database to ensure data integrity and timeliness of portal submissions.
- Prepare provider financial sanctions for review prior to submission.
- Serve as primary point of contact to resolve provider issues regarding IADs and QOCs.
High school diploma or equivalent. 2+ years of experience in a health care setting that includes coordination of member care through physicians, clinical nurses and office managers. In depth knowledge of medical/mental health terminology required.
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.