Behavioral Health Quality Improvement Lead (Remote)

Centene Corp.; Baton Rouge (LA); Remote; USD 46,000 - 84,000; Full time

Job summary

Centene Corp. seeks a Quality Improvement Coordinator for Behavioral Health to analyze and monitor clinical QI activities, ensure NCQA compliance, and support appeals processes.

You will lead quality initiatives, review clinical information, and prepare case reviews with a focus on medical necessity and regulatory timelines. The role requires an Associate's Degree in Nursing or related field, 2+ years in clinical nursing or behavioral health, and 1+ year in quality, managed care, or healthcare

Qualifications

• Associate's Degree in Nursing or related field required.
• 2+ years in Clinical Nursing or Behavioral Health required.
• 1+ years experience in Quality, Managed Care or Healthcare Administration required.

Responsibilities

• Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives.
• Review clinical information for appeals to determine medical necessity of services and prepare reviews for cases.
• Act as the liaison for appeals and fair hearings and lead Behavioral Health Performance Improvement Projects (PIPS).
• Maintain files and documentation in accordance with NCQA and State standards and regulations, including timelines.
• Investigate and resolve behavioral health quality of care complaints and grievances.

Skills

Quality Improvement

Behavioral Health

Clinical Appeals

Education

Associate's Degree in Nursing or related field

Job description

Centene Corp. seeks a Quality Improvement Coordinator for Behavioral Health to analyze and monitor clinical QI activities, ensure NCQA compliance, and support appeals processes.

You will lead quality initiatives, review clinical information, and prepare case reviews with a focus on medical necessity and regulatory timelines. The role requires an Associate's Degree in Nursing or related field, 2+ years in clinical nursing or behavioral health, and 1+ year in quality, managed care, or healthcare