Quality Improvement Coordinator II

Centene Corporation; Wisconsin; Hybrid; USD 46,000 - 84,000; Full time

Job summary

Centene Corporation is seeking a Quality Improvement professional to review delegated entities for compliance, perform clinical audits, and develop action plans to improve care quality.

The role involves coordinating with the Medical Director and QIC, analyzing data, and communicating findings to stakeholders. A nursing background and several years in healthcare quality are preferred, with flexible work arrangements offered.

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.

Responsibilities

• Perform quality on site reviews of delegated entities, physician offices/clinics and generate written findings.
• Document, investigate and resolve complaints, risk management and sentinel events related to quality of care.
• Audit medical records and analyze data for quality improvement studies and activities.
• Coordinate QIC activities and monthly meetings with delegated entities.
• Develop and implement Corrective Action Plans and monitor outcomes.
• Identify best practices and suggest program enhancements.

Skills

Quality improvement

Healthcare experience

Data analysis

Education

Bachelor’s degree in Nursing

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.

Abstractions and Overread experience highly preferred.

MedSurge experience highly preferred.

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.
• Perform 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

Centene offers a comprehensive benefits package including:

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