Quality Improvement Coordinator II

Centene Management Company LLC; Washington; Hybrid; USD 46,000 - 84,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K plans

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Management Company LLC in Washington state seeks a qualified Quality Improvement professional to oversee reviews of delegated entities for quality, service and utilization, and to perform on-site audits with data-driven follow-up.

The role requires RN licensure in WA, 3+ years in healthcare quality, and 2+ years in quality function within healthcare. Some travel for intervention health events is expected.

Qualifications

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

Responsibilities

• Audit delegated entities for compliance with quality, service performance and utilization.
• Perform credentialing reviews and medical record audits.
• Lead community activities related to clinical initiatives and health events.
• Coordinate QIC activities and enforce data submission per contract.
• Develop and implement Corrective Action Plans and quality improvement reports.
• Investigate complaints and risk management related to quality of care issues.

Education

Bachelor’s degree in Nursing

LPN/LVN/RN/PA/LCSW license preferred

CPHQ certification preferred

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.

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.

Pay Range: $33.71 - $60.67 per hour

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.

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.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.