You could be the one who changes everything for Centene’s 28 million members by improving HEDIS performance across physician practices, IPAs, and large physician groups.
Compensation Base pay range: $26.50/hr – $47.59/hr. Actual pay will be adjusted based on skills, experience, education and other factors permitted by law.
Responsibilities Establish and foster healthy working relationships between large physician practices, IPAs, and Centene.
Educate providers and support provider practice sites regarding NCQA HEDIS measures, risk adjustment, medical record documentation, and appropriate coding.
Collect, summarize, trend, and deliver provider quality and risk adjustment performance data to identify and coach opportunities for improvement and gap closure.
Collaborate with Provider Relations and other provider‑facing teams to improve provider performance in Quality, Risk Adjustment, and Operations (claims and encounters).
Identify specific practice needs where Centene can provide support and develop, enhance, and maintain provider clinical relationships across product lines.
Maintain Quality KPIs and ensure HEDIS abstraction accuracy rates meet corporate standards.
Travel up to 75 % of time to provider offices.
Perform other duties as assigned and comply with all policies and standards.
Qualifications Bachelor’s Degree or equivalent required.
3+ years in HEDIS record collection and risk adjustment (coding) required.
One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC‑A, or CBCS.
Must reside in IL or within a reasonable driving distance to assigned providers.
Benefits Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to remote, hybrid, field or office work schedules.
Equal Opportunity Employer Centene is an equal opportunity employer 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.