Quality Improvement Coordinator II

centene; Washington; Hybrid; USD 50,000 - 84,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a qualified quality improvement professional in Washington state. The role conducts on-site reviews of delegated entities for quality, service performance and utilization, and performs audits of medical records to drive improvements.

The successful candidate will have a Nursing degree, RN license (WA preferred), and 3+ years in healthcare quality. Some travel and PST hours are required, with a comprehensive benefits package including health insurance and 401K.

Qualifications

• Bachelor's degree in Nursing required or preferred.
• RN licensure preferred; other licenses (LPN/LVN/PA/LCSW) may be considered.
• 3+ years clinical, quality improvement or healthcare experience.
• 2+ years quality function experience in healthcare setting.

Responsibilities

• Perform on-site quality reviews of delegated entities and providers.
• Investigate and resolve formal/informal quality-related complaints and risks.
• Audit medical records and analyze data for quality improvement studies.
• Coordinate QIC activities and monthly meetings.
• Develop and implement Corrective Action Plans.
• Prepare utilization and quality reports and enforce data submission terms.

Skills

RN licensed WA state

WA state resident

Education

Bachelor's degree in Nursing

CPHQ certification

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Strongly preferred qualifications

• *RN licensed in WA state
• *Candidate residing in WA state

Position will work PST hours and requires some travel for intervention health events.

Position Purpose

Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers.

• Perform quality on site reviews of delegated entities, physician office/clinics, resolve quality issues, generate written summary of findings and follow up as directed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC).
• Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care issues.
• Audit medical records, review administrative claims and analyze data and interventions for quality improvement studies and activities
• Function as the primary liaison between community resources/agencies and the company related to clinical initiatives and technical guidance.
• Schedule and chair meetings with delegated entities in accordance with their contract.
• Gather data and compile various utilization and quality improvement reports.
• Develop and implement Corrective Action Plans.
• Recommend changes/enhancements to the Quality Improvement policies and procedures.
• Identify best practices, research new processes and recommend program enhancements.
• Coordinate QIC activities and monthly meetings.
• Oversee the enforcement of contract terms regarding data submission for delegated entities.
• Participate in the development of reporting and data outcome reports.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience

Bachelor's degree in Nursing preferred. 3+ years of clinical, quality improvement or healthcare experience. 2+ years of experience in quality function in a healthcare setting.

License/Certification

LPN, LVN, RN, PA, or LCSW license preferred. CPHQ (Certified Professional in Healthcare Quality) preferred.

Strongly preferred qualifications

• *RN licensed in WA state
• *Candidate residing in WA state

Position will work PST hours and requires some travel for intervention health events.

Pay Range: $33.71 - $60.67 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and 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.

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