Behavioral Health QI Specialist – Remote/Hybrid

Centene Corporation; Baton Rouge (LA); Hybrid; USD 46,000 - 84,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene Corporation seeks a qualified professional to analyze, develop, and monitor clinical quality improvement activities, ensuring alignment with customer expectations. You will lead Behavioral Health improvement projects and review clinical information for appeals to determine medical necessity.

The role requires an RN or licensed mental health professional and experience in Quality/Managed Care. The position offers a remote/hybrid schedule within Louisiana and full benefits including

Qualifications

• RN or licensed mental health professional required.
• Experience in Quality, Managed Care, or Healthcare Administration preferred.

Responsibilities

• Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives.
• Lead Behavioral Health Performance Improvement Projects (PIPs).
• Review clinical information for appeals to determine medical necessity.
• Prepare cases for appeals that do not meet medical necessity.
• Maintain files and logs in accordance with NCQA and state standards.
• Investigate and resolve behavioral health quality of care complaints and grievances.

Skills

Nursing

Behavioral Health

Quality Assurance

Education

Associate's Degree in Nursing or related field

Job description

Centene Corporation seeks a qualified professional to analyze, develop, and monitor clinical quality improvement activities, ensuring alignment with customer expectations. You will lead Behavioral Health improvement projects and review clinical information for appeals to determine medical necessity.

The role requires an RN or licensed mental health professional and experience in Quality/Managed Care. The position offers a remote/hybrid schedule within Louisiana and full benefits including