Quality Improvement Coordinator II - Clinical

SilverSummit Healthplan; Nevada; Hybrid; USD 46,000 - 84,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedule: remote, hybrid

Job summary

Centene is seeking a Quality Improvement professional to coordinate and monitor corporate and health plan–level quality initiatives in line with NCQA and URAC standards. The role involves policy development, data collection, and cross-functional project support to drive compliance and program enhancements.

Ideal candidates hold a Nursing degree with 3+ years clinical experience and at least 1 year in a quality function, including policy writing for accreditation readiness.

Qualifications

• Bachelor’s degree in Nursing or related medical field; RN/LPN/LVN preferred.
• 3+ years clinical experience and 1+ year in a quality function.
• Hands-on experience writing and implementing policies to support NCQA/URAC or JCAHO accreditation standards.
• Basic understanding of health insurance business, claims payment procedures, and healthcare trends.

Responsibilities

• Coordinate and monitor quality improvement and organizational projects from inception to closure.
• Assist with plan compliance to NCQA/URAC standards with the Director of Accreditation.
• Maintain Quality Improvement policies and procedures in line with NCQA/URAC requirements.
• Identify best practices and research new processes to enhance programs.
• Support the project life cycle including requirements gathering, project plans, resource management and deployment.
• Assist with data collection and presentation for QI projects; identify data sources and timelines.
• Perform other duties as assigned and comply with all policies.

Skills

Clinical experience

Quality function experience

Policy writing

Education

Bachelor’s degree in Nursing or related medical field

Job description

Position Purpose

Coordinate and monitor quality improvement and organizational projects from inception to closure. Perform duties and functions as required to develop and implement quality improvement programs and initiatives at both the corporate and individual health plan levels according to NCQA, URAC and State requirements.

Position Purpose

Coordinate and monitor quality improvement and organizational projects from inception to closure. Perform duties and functions as required to develop and implement quality improvement programs and initiatives at both the corporate and individual health plan levels according to NCQA, URAC and State requirements.

Key Details: Candidate must live in NV.

• Work with Director of Accreditation to assist with Plan compliance to NCQA/URAC standards.
• Maintain Quality Improvement policies and procedures in compliance with NCQA/URAC requirements and recommend changes/enhancements as indicated.
• Identify best practices, research new processes and recommend overall program enhancements.
• Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources and facilitate project execution, deployment and closure.
• Assist with collection and presentation of data for identified QI projects; identifying sources, methodology and timeliness for which data is needed.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience

Bachelor’s degree in Nursing or related medical field preferred. 3+ years clinical experience and 1+ years of experience in a quality function. Hands on experience with writing and implementing policies and procedures to support NCQA/URAC or JCAHO accreditation standards preferred. Basic understanding of health insurance business, claims payment procedures, strategies and trends in health care preferred.

License/Certification:

RN, LPN or LVN. Current state nursing license and valid driver’s license. CPHQ preferred.

Pay Range: $33.71 - $60.67 per hour

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.

Centene offers a comprehensive benefits package including:

• 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.