Provider Quality Liaison - #9754672

Jobs for Humanity is partnering with Centene Medicare to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located.

Company Name: Centene Medicare

Join our team and make a difference in the lives of our 28 million members. Centene is dedicated to improving community health, one person at a time. We provide competitive benefits and offer workplace flexibility to ensure a fresh and inclusive environment.

Position: Quality Assurance Coordinator (Must Reside in Tennessee)

Responsibilities:

• Connect with plan providers to promote quality initiatives and monitor key performance indicators.
• Share important reports and gap lists with providers, including HEDIS, CAHPS, HOS, Part D, and Administrative Operations.
• Collaborate with providers and internal partners to address performance barriers, improve low-performing measures, and share best practices for quality improvement.
• Educate providers on HEDIS measures, medical record documentation guidelines, and Member Experience measures.
• Serve as an ongoing resource for providers, offering support and resolving issues related to performance measures, pay for performance, member assessments, health outcomes, complaints, disenrollments, appeals, and grievances.
• Work with Provider Relations and other teams to enhance provider performance in quality measures.
• Build and maintain strong relationships with providers across different product lines (Medicare, Medicaid, Ambetter).
• Reach out to members via phone to encourage visits to physicians and close care gaps.
• Perform other assigned duties.

Requirements:

• High school diploma or GED equivalent (Associate’s degree preferred).
• 2+ years of experience in clinical and member experience quality.
• Intermediate knowledge of Excel, Word, and PowerPoint.
• Driver’s License required. Pharmacy Technician, Medical Assistant, Licensed Vocational Nurse, Licensed Practical Nurse, or Social Work licensure preferred.

Benefits:

• Flexible work solutions, including remote options and hybrid schedules.
• Competitive pay.
• Paid time off, including holidays.
• Health insurance coverage for you and your dependents.
• 401(k) and stock purchase plans.
• Tuition reimbursement and top-notch training opportunities.

Centene is an equal opportunity employer committed to diversity and inclusivity. We value our differences and welcome applicants from all backgrounds, including elderly individuals, refugees, people with visible and invisible disabilities, LGBTQIA+ individuals, veterans, and more. 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.