Healthcare Quality Improvement Specialist (Hybrid/Remote)

Centene Corporation; Phoenix (AZ); On-site; USD 46,000 - 84,000; Full time

Job summary

Centene Corporation in Arizona seeks a Quality Reviewer to conduct on-site reviews of delegated entities and physician offices, audit records, and support quality improvement initiatives. You will analyze data, investigate complaints, and coordinate corrective actions to ensure adherence to quality standards.

The role requires collaboration with healthcare providers and community partners, with a focus on improving care quality and performance in Centene’s network.

Qualifications

• Bachelor’s degree in Nursing preferred; 3+ years clinical/quality healthcare experience.
• 2+ years experience in quality function in a healthcare setting.
• CPHQ certification preferred; LPN/LVN/RN/PA/LCSW license preferred.

Responsibilities

• Perform on-site quality reviews of delegated entities, physician offices and clinics.
• Audit medical records, review administrative claims and analyze data for quality improvement.
• Document and resolve complaints and risk management events related to quality of care.
• Coordinate QIC activities and monthly meetings; develop corrective action plans.
• Prepare utilization and quality reports and enforce data submission terms.

Skills

Quality improvement

Data analysis

Healthcare operations

Education

Bachelor’s degree in Nursing

Job description

Centene Corporation in Arizona seeks a Quality Reviewer to conduct on-site reviews of delegated entities and physician offices, audit records, and support quality improvement initiatives. You will analyze data, investigate complaints, and coordinate corrective actions to ensure adherence to quality standards.

The role requires collaboration with healthcare providers and community partners, with a focus on improving care quality and performance in Centene’s network.