Provider Quality Liaison (Multiple Positions)
Location: Coos Bay
Posted on: July 16, 2021
Position Purpose: 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.
Education/Experience: 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
- 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
- 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
- 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 interventions 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
- 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
- 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
- Serve as primary point of contact to resolve provider issues
regarding IADs and QOCs.
Candidates with HEDIS, CAHPS measures experience are highly
preferred. Candidates must have experience working with providers
with advanced interpersonal skills.
Flexible hours; flex work arrangements; some travel to provider
office required post COVID 19
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.
Keywords: Centene, Eugene , Provider Quality Liaison (Multiple Positions), Other , Coos Bay, Oregon
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