Associate Quality Practice Advisor

Centene Corporation

. Establish and foster healthy working relationships between community physicians, small provider practices and WellCare .

Posted 11/4/2026full-timeRemote • Michigan • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in HEDIS measures, medical record documentation, and quality improvement processes while effectively collaborating with healthcare providers to enhance performance and compliance. Proficient in data collection, analysis, and education to support provider practices and ensure adherence to regulatory standards.

Highest-signal resume keywords

HEDIS Measures KnowledgeMedical Record DocumentationQuality Improvement ExperienceData Collection and AnalysisConsultation and Education Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

HEDIS ICD-9/10 CPT CodingData and Chart ReviewsPerformance Data SummarizationQuality Metrics ReportingRegulatory Compliance

Soft Skills

Relationship BuildingCoaching ProvidersCommunication SkillsProblem-SolvingCollaboration

Tools & Technologies

DatabasesPerformance Metrics ToolsEducational Resources

Certifications & Qualifications

CCSLPNLMSWLVNLMHCLMFTLCSWRNAPRN (ACNP-BC)HCQM

Industry Keywords

Managed CareNCQA StandardsHealthcare QualityProvider RelationsWellness Education

About the role

Key responsibilities & impact

Establish and foster healthy working relationships between community physicians, small provider practices and WellCare
Educate providers and support provider practice sites regarding NCQA HEDIS measures
Provide education on HEDIS measures, medical record documentation and appropriate coding
Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS standards
Collect, summarize and trend provider performance data to identify improvement opportunities
Collaborate with Provider Relations to improve Quality, Risk Adjustment and Operations performance
Deliver provider-specific metrics and coach providers on gap-closing opportunities
Identify practice needs where WellCare can provide support
Partner with physicians and staff to encourage member clinical participation in wellness and education
Provide resources and educational opportunities to providers and staff
Capture concerns and issues in provider action plans
Document action plans, visit details and outcomes
Report critical incidents and quality-of-care issues
Gather data from external sources as needed to measure outcomes
Create newsletters, member education, outreach interventions and provider education
Support HEDIS quality-improvement and program studies, including requesting records, maintaining databases and researching provider encounter history
Ensure documentation complies with state regulations and accrediting-body requirements
Ensure regulatory report content is accurate and submitted by deadlines
Enter findings into databases and ensure medical-record data accuracy
Perform other duties as assigned and comply with policies and standards

Requirements

What you’ll need

Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field, or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets
1+ year of experience in related HEDIS medical record review or quality improvement with experience in data and chart reviews to provide consultation and education to providers and provider staff, OR 2 years medical coding or other transferable experience and skill set combination
Strong quality experience, including presenting to and partnering with providers
Knowledge of HEDIS measures, medical record documentation and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements
Ability to collect, summarize and trend provider performance data
Ability to provide consultation and education to providers and provider staff
Up to 50% travel required
Preferred: Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field
Preferred license/certification: CCS, LPN, LMSW, LVN, LMHC, LMFT, LCSW, RN, APRN (ACNP-BC), foreign-trained physician/MD, HCQM, CHP or CPHQ

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation