Clinical Quality Coordinator (RN)

Centene; United States; Remote; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work with remote options

Job summary

Centene is seeking an experienced Registered Nurse to conduct member and provider outreach, perform chart reviews, and coordinate services to close HEDIS care gaps. The role emphasizes education, scheduling support, and comprehensive assessments to evaluate independence and follow-up needs.

Responsibilities include collaborating with PCPs and specialists, adapting to campaign changes, and maintaining a caseload while supporting quality initiatives in a remote work setting across US Eastern or

Qualifications

• Bachelor's Degree in Nursing required.
• Master's Degree in Nursing preferred.
• 2+ years Clinical Nursing in an acute care setting required.
• 1+ years Case management or quality improvement in a managed care setting required.
• Experience in a government sponsored managed care program preferred.
• RN - Registered Nurse licensure required.

Responsibilities

• Educate members about needed screenings and encourage scheduling appointments.
• Complete assessments to review independence, fall history, and physician follow-up needs.
• Coordinate services between PCPs, specialists, medical providers, and non-medical staff for care gap closure.
• Provide patient and provider education and facilitate access to community services.
• Identify quality concerns and report to appropriate resources.
• Support direct care gap closure through outreach and documentation.

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

2+ years Clinical Nursing in an acute care setting

1+ years Case management or quality improvement in a managed care setting

Experience in a government sponsored managed care program

RN Licensure

Job description

Position Purpose

Conduct member outreach, provider outreach, and chart review to assess, plan, gather information, and coordinate medical and supporting services across the continuum of care to support both direct and indirect HEDIS care gap closure.

Job Responsibilities

• Educate members about needed screenings, including diabetic and breast cancer screenings.
• Encourage members to schedule appointments and assist with scheduling as needed.
• Complete assessments, including the Conditions of Older Adults assessment, to review members' independence, fall history, and need for physician follow-up.
• Adapt to changing outreach campaigns, priorities, and processes.
• Work from home in the Eastern or Central time zone.
• Approximately 8:00 a.m.-5:00 p.m., with adjustments based on your time zone and business needs.
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary support care gap closure activities.
• Provide patient and provider education
• Facilitate member access to community based services
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Support direct care gap closure of HEDIS measures through member outreach, assessment, and documentation of member status.
• Provide clinical support as needed to outreach coordinators interacting with high-risk members and/or providers to improve healthcare outcomes and close care gaps. Provides support for quality initiatives including outreach to members who are noncompliant in the designated outreach services.
• Maintain a caseload of members to provide education to members/guardians to support improved healthcare outcomes and see them through care gap closure activities, such as childhood immunizations.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience

• Bachelor's Degree Nursing required
• Master's Degree Nursing preferred
• 2+ years Clinical Nursing in an acute care setting required
• 1+ years Case management or quality improvement in a managed care setting required
• Experience in a government sponsored managed care program preferred
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range

$56,200.00 - $101,000.00 per year

About Centene

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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.

Equal Opportunity

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