Quality Improvement Coordinator II – Healthcare Compliance

Centene Corporation; United States; A distancia; USD 46.000 - 84.000; Jornada completa

Descripción de la vacante

Centene Corporation in the United States seeks a healthcare quality reviewer to conduct on-site reviews of delegated entities, audit medical records, and drive quality improvement initiatives. You will document findings, manage complaints and risk events, and prepare data reports for leadership.

The role requires nursing licensure (LPN/LVN/RN/PA) with 3+ years in clinical or quality roles and CPHQ preferred.

Formación

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

Responsabilidades

• Perform on-site reviews of delegated entities for quality, service performance and utilization.
• Audit medical records and analyze data for quality improvement studies.
• Document, investigate and resolve complaints and risk events related to quality of care.
• Coordinate QIC activities and chair meetings.
• Develop and implement Corrective Action Plans.
• Prepare utilization and quality improvement reports.
• Oversee enforcement of contract data submission terms.
• Identify best practices and develop program enhancements.
• Comply with all policies and standards.

Conocimientos

Quality improvement

Clinical experience

Data analysis

Communication

Educación

Bachelor’s degree in Nursing

Descripción del empleo

Centene Corporation in the United States seeks a healthcare quality reviewer to conduct on-site reviews of delegated entities, audit medical records, and drive quality improvement initiatives. You will document findings, manage complaints and risk events, and prepare data reports for leadership.

The role requires nursing licensure (LPN/LVN/RN/PA) with 3+ years in clinical or quality roles and CPHQ preferred.