Find & Apply For Clinical Auditor / Utilization Reviewer Jobs in Corpus Christi, Texas

Quality Practice Advisor Superior HealthPlan - 3.5 Corpus Christi, TX Job Details Full-time $27.02 - $48.55 an hour 17 hours ago Benefits Paid holidays Health insurance 401(k) Tuition reimbursement Paid time off Qualifications

CPHQ LMFT LMHC

Medical performance measurement report preparation Quality control experience within healthcare industry LVN RN License HCQM Certification Quality of care (regulatory compliance area) LMSW Health education for healthcare providers Coaching Licensed Clinical Social Worker APRN Gap analysis Medical coding experience in physician offices Mid-level RHIT 3 years Quality reports Certified Professional Coder Clinical audit and monitoring Bachelor's degree Clinical performance metrics Certified Coding Specialist Medical record abstraction Continuous clinical improvement initiatives LPN Quality audits Certified Risk Coder (CRC) Full Job Description You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT •This position is a hybrid role that requires fieldwork. Qualified candidates must reside in the state of Texas in the fol lowing area: Corpus Christi• Highly preferred licenses/certifications:

LVN, RN, CPC, CPC-A, CRC, or CPHQ Position Purpose:

Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers. Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and

HEDIS ICD-9/10 CPT

coding in accordance with state, federal, and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationship across product lines. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards. Ability to travel up to 75% of time to provider offices. Performs other duties as assigned. Complies with all policies and standards.

Education/Experience:

Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required

Licenses/Certifications:

One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS Registered Health Information Technician (RHIT®): For positions aligned to a corporate line of business that report into and operate within a state specific health plan, state requirements apply

For Superior HealthPlan:

license/certification is preferred

Pay Range:

$27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act