Maternity Clinical Practice Advisor

Company: SilverSummit Healthplan
Location: Las Vegas
Posted on: February 15, 2025

Job Description:

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

• Strategic development and maintenance of clinical oriented partnerships with OBGYN providers, hospital systems, and community-based organizations to improve maternal/infant child health outcomes.
  
  • Design and implement practice level performance improvement projects including providing education to providers and office staff on proper clinical documentation, coding and billing practices that relate to clinical utilization metrics.
    
    • Serve as subject matter expert for maternity care topics including birth outcomes such as: primary c-section rates, preterm birth rates, low birth weight rate, maternity morbidity and mortality, infant mortality rates, substance use disorder in pregnancy, perinatal mood disorder in pregnancy, congenital syphilis, long-active reversible contraception (LARC) devices, CARA plan of care, prenatal and infant immunizations.
      
      • Participate, coordinate, and or represent the health plan at community-based organization events, and committees focused on improving maternal outcomes, mother/child health education, quality improvement and other programs.
        
        • Collaborate cross-functionally with the Quality Improvement (QI) department to design and implement practice level performance improvement projects focused on improving maternity utilization outcomes and increasing HEDIS performance.
          
          • Develop and design educational content and resource materials focused on improving maternal care, better mother/child health outcomes, prioritizing mental health for mothers, and other maternity care topics.
            
            • Ability to travel to physicians' offices locally 75% of the time. Able to travel to Northern and rural Nevada to meet with OBGYN and other community-based organizations.
              
              • Provide expert direction and guidance on provider-focused clinical utilization and quality improvement programs.
                
                • Support the Quality Improvement (QI) department by facilitating medical record retrievals during HYBRID project by leveraging relationships with OBGYN providers to secure access to medical records and or access to providers electronic health record (EHR).
                  
                  • Identifies population-based member barriers to prenatal, postpartum and preventative care and works with internal and external teams to develop strategies to cover barrriers.
                    
                    • Supports continuum of member care by identifying members in need of health education and/or services (case management, social services, etc.) and refers members to the appropriate internal department.
                      
                      • Works with OBGYN Providers on standards of care and advises providers on established clinical practice guidelines, and appropriate documentation.
                      • Performs other duties as assigned
                        
                        • Complies with all policies and standards
                          ***Candidate for this role must be in Las Vegas, NV.
                          
                          This position requires up to 75% travel to hospitals and provider offices.
                          
                          Responsible for strategically developing clinical oriented provider and community partnerships in order to improve maternal outcomes. The Maternity Clinical Practice Advisor (MCPA) will work closely with the Quality Improvement (QI) department to coordinate an interdisciplinary approach to increasing HEDIS and maternity utilization outcome performance. This position is responsible for providing direction and guidance on provider-focused clinical utilization/quality improvement programs. The role will assists contracted OBGYN providers with analyzing member care, trending utilization and quality performance, and developing performance improvement plans to support OBGYN provider practices using current clinical guidelines, HEDIS, CMS, NCQA and other tools. Job duties include but are not limited to: the ongoing management of OBGYN provider office relationships, development and implementation of clinical initiatives, participation in external and internal maternity related committees. This position reports to the Population Health Leadership.
                          
                          Education/Experience:
                          Graduate from an Accredited School of Nursing required:
                          Bachelor's Degree in Nursing preferred: 4+ years Clinical experience working in Labor & Delivery, Antepartum Care, Postpartum, newborn nursery required
                          
                          4+ years Neonatal Intensive Care Unit preferred:
                          Knowledge of one or more of: Clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
                          Current unrestricted RN licensure in the state of Nevada required
                          
                          CLC - Certified Lactation Consultant within 1 Year preferred:
                          Pay Range: $68,700.00 - $123,700.00 per year
                          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. Total compensation may also include additional forms of incentives.
                          
                          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

Keywords: SilverSummit Healthplan, Las Vegas , Maternity Clinical Practice Advisor, Healthcare , Las Vegas, Nevada