Behavioral Health Quality Improvement Lead - Remote/Hybrid

Centene Corporation; Oregon; Ibrido; USD 46.000 - 84.000; Tempo pieno

Descrizione del lavoro

Centene Corporation in Oregon is seeking an experienced clinical quality professional to analyze, develop, and monitor QI activities ensuring alignment with customer expectations. You will review appeals for medical necessity and liaison for fair hearings, with a focus on behavioral health quality and NCQA compliance.

The role requires an RN or related field with relevant behavioral health and quality experience, offering a competitive hourly pay and a comprehensive benefits package.

Competenze

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

Mansioni

• Develop and implement the quality program description, work plan goals including HEDIS measures and program evaluation for behavioral health.
• 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, logs, and documentation per NCQA and state standards with timelines.
• Investigate and resolve behavioral health quality of care complaints and grievances.
• Performs other duties as assigned.
• Complies with all policies and standards.

Conoscenze

Clinical nursing

Behavioral health

Quality management

Healthcare administration

Formazione

Associate's degree in Nursing

RN certification

LMHC or LPC license

Descrizione del lavoro

Centene Corporation in Oregon is seeking an experienced clinical quality professional to analyze, develop, and monitor QI activities ensuring alignment with customer expectations. You will review appeals for medical necessity and liaison for fair hearings, with a focus on behavioral health quality and NCQA compliance.

The role requires an RN or related field with relevant behavioral health and quality experience, offering a competitive hourly pay and a comprehensive benefits package.