PA Health & Wellness · 1 day ago
Provider Quality Liaison
Florida, United States
Full-time
Onsite
Entry Level
$19.43/hr - $32.98/hr
2+ years expCentene is transforming the health of our communities, one person at a time, and they are seeking a Provider Quality Liaison to connect with plan providers regarding quality initiatives. The role involves collaborating with providers to improve performance measures and supporting quality improvement interventions across various product lines.
FitnessHealth CareWellness
Responsibilities
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), Rx Effect, 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 performance
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
Complies with all policies and standards
Qualification
Required
Must Reside in FL
Quality / HEDIS Measure
Excellent Customer Service and Communication Skills
Attention to Details
Microsoft Applications
Ability to Build Trusting Relationships with Provider Groups
High school diploma or equivalent
2+ years of experience with clinical and member experience quality
Driver's License required
Preferred
Associate's degree preferred
Pharmacy Technician, Medical Assistant Licensed Vocational Nurse, Licensed Practical Nurse, Social Work licensure preferred
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
PA Health & Wellness
Established to deliver quality healthcare in the state of Pennsylvania through local, regional and community-based resources, PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation (Centene).
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Justin Davis
President and Chief Executive Officer
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