Co-leads interdisciplinary teams on complex projects, acts as a consultant on regulatory and quality issues, and designs educational programs to enhance safety and quality for employees and leadership.

Title: Provider Quality Liaison Location: Remote-AR Full time 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. Candidate must reside in Arkansas. Position is hybrid, requiring 50-75% travel to provider offices. Prior experience in quality improvement, provider education, or population health strongly preferred. Position Purpose: Responsible for connecting with plan providers regarding quality initiatives and key quality performance indicators. Shares HEDIS, CAHPS, HOS, Part D and Administrative Operations reports and gap lists with providers. Use existing resources to collaborate with provider offices and internal partners on performance measure barriers, actions to mitigate low performing measures, and the sharing of quality best practices to support providers. - 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), RxEffect, 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 Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years of experience with clinical and member experience quality. License/Certification: Driver’s License required. Pharmacy Technician, Medical Assistant Licensed Vocational Nurse, Licensed Practical Nurse, Social Work licensure preferred. Candidate must reside in Arkansas. Position is hybrid, requiring 50-75% travel to provider offices. Prior experience in quality improvement, provider education, or population health strongly preferred. Pay Range: $19.43 - $32.98 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.

Title: RN Care Manager (Medicaid) Location: Rockville, MD, USA Employees work in a hybrid mode - Full-time - Department: Clinical Operations - Market Job Description: Travel: 25% Travel throughout our MD Market, Must be located in the DMV, MD Highly Preferred The Maryland Primary Care Program (MDPCP AHEAD) RN Care Coordinator will work closely with Primary Care providers in the state of Maryland to identify, screen, track, monitor, and coordinate the care of patients with multiple chronic conditions to develop and deliver Comprehensive Primary Care to patients. Our Care Coordinators seek to develop, implement, and deliver extensive care coordination within our medical group and affiliated partners in a patient centered manner. They interact and collaborate with interdisciplinary care teams, population health teams, networked facility partners, physicians, and others involved in meeting the patient's needs. - Ensure high quality care for patients by reviewing and researching concerns or complaints and recommending corrective action as appropriate. - Identify and recommend solutions to issues and problems. - Maintain excellent communication and effective working relationships with patients, office managers, providers and clinical team members - Collaborate with assigned local teams to meet Maryland Primary Care Program (MDPCP AHEAD) performance metrics - Collaborate effectively with integrated care team to support care coordination for patients - Review patient non-compliance reports and conduct telephonic and/or in person outreach to ensure timely disease specific and wellness visits - Provide Transitional Care Management including, but not limited to, post in-patient and/or emergency department discharge follow up - Provide education and assistance as it relates to lifestyle coaching, dietary improvements and plans - Provide education and assistance in accessing the necessary care outside of the Primary Care Office - Collaborate with providers to review high-risk patients, develop a plan of care, and administer Care Plan to patients - As needed, meet patients in the office or community for face-to-face visits - Provide education and assistance with patient self-management goals - Identify and coordinate referrals to community resources, home care, and disease management programs within Privia Preferred Network - Operate independently within defined practice(s) and patient population to achieve agreed upon goals - Attendance and participation in regular care team meetings to discuss patient care - Perform other duties as assigned - Must have Active RN License - 2+ years of population health or care coordination experience - Strong computer and EHR skills and expertise - Preferred experience with Medicaid patients in a value-based program - Preferred experience educating and engaging patients - Experience working in an outpatient medical office - Ability to travel to and from care centers to meet with patients and providers - Must comply with all HIPAA rules and regulations - Bilingual candidates are encouraged to apply (especially those who speak Spanish) The salary range for this role is $75,000.00 to $85,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location All your information will be kept confidential according to EEO guidelines. Technical Requirements (for remote workers only, not applicable for onsite/in office work): In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost. Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.

Patient Care Navigator - MRI Job category: Administrative Support Requisition number: PATIE002222 Full-time Hybrid Des Moines Orthopaedics - West Des Moines West Des Moines, IA 50266, USA Description Are you a kind and reliable resource? As a Patient Care Navigator at DMOS, you will guide patients through their orthopaedic journey with us by scheduling Advanced Imaging after attaining prior authorizations. In this full-time position you will work alongside a team of patient care navigators and MRI Technologists to create an outstanding patient experience. To thrive in this role, you are able to recall information quickly and prioritize tasks accordingly. Here is What You Can Expect: - Acting as the patient's guide and reliable helper for advanced imaging authorization and appointment scheduling. - Utilizing Office 365 products to organize MRI schedules, insurance prior authorizations and communicating with clinical staff when needed. - This is a private practice that expects outstanding experiences for patients throughout their orthopaedic journey. - Sitting at a desk for extended periods of time that may seem unnatural. - Work from home available after training is complete What We're Looking For: - Calm. Ability to communicate calmly with patients and technicians. - Professional. Display a high-level of professionalism when interacting with patients and clinical staff members. - Multi-tasker. Ability to handle multiple tasks at one time while staying organized. - Curiosity. You practice the art of listening, asking clarifying questions and avoiding interrupting. - Experience. Prior exposure to patient care coordination. - Dependability. Ensures patients receive timely care, promotes a reliable healthcare environment, and supports the overall efficiency of the team. Why DMOS? - Consistent schedule, no weekend coverage - Friendly, fun and dedicated peers - Outstanding 401(k) with employer match and an annual company profit sharing contribution (even if you don't participate in the employer match) - Health, dental, and vision insurance including 6 paid holidays and a generous PTO accrual program (as a full-time employee you can anticipate to earn up to 22 days per year) Join our team of orthopaedic surgeons and discover how your talents will change lives helping our patients get back to living! Qualifications Education Required H.S. GED or Diploma or better in General. Experience Preferred 1 year: Medical Reception or Coordination