Quality Improvement Coordinator II — Healthcare QA & Compliance (AZ)

Arizona Complete Health; Arizona; Ibrido; USD 46.000 - 84.000; Tempo pieno

Descrizione del lavoro

Centene is seeking a Quality Review professional in Arizona to conduct on-site reviews of delegated entities, focusing on quality of care, utilization, and credentialing processes. The role involves data analysis, liaisonwork with community resources, and leading meetings to ensure contract compliance.

Ideal candidates have nursing credentials and 3+ years in clinical or quality-improvement roles, with 2+ years in healthcare quality functions.

Competenze

• 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.

Mansioni

• 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

Conoscenze

Quality improvement

Healthcare experience

Formazione

Bachelor's degree in Nursing

Descrizione del lavoro

Centene is seeking a Quality Review professional in Arizona to conduct on-site reviews of delegated entities, focusing on quality of care, utilization, and credentialing processes. The role involves data analysis, liaisonwork with community resources, and leading meetings to ensure contract compliance.

Ideal candidates have nursing credentials and 3+ years in clinical or quality-improvement roles, with 2+ years in healthcare quality functions.