Provider Quality Liaison

Requirements

• Connecting with plan providers regarding quality initiatives and key quality performance indicators
• Sharing HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers
• Educating provider practices in appropriate HEDIS measures, medical record documentation guidelines and Member Experience measures
• Acting as an ongoing resource to providers for quality improvement via regular touch points and meetings
• Educating, supporting, and resolving provider practice sites issues around P4P, RxEffect, CAHPS, HOS, CTMs, Disenrollments, Appeals, and Grievances
• Collaborating with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures)
• Developing, enhancing and maintaining provider relationship across all product lines (Medicare, Medicaid, Ambetter)
• Conducting telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps
• Performing other duties as assigned
• Complying with all policies and standards

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedule