Quality Improvement Specialist

Meridian; Illinois; Remote; USD 55,000 - 99,000; Full time

Job summary

An established industry player is seeking a Quality Improvement Specialist to enhance healthcare quality for millions. This remote role focuses on developing quality improvement initiatives and ensuring compliance with regulatory standards. The ideal candidate will leverage their analytical skills to monitor care quality, collaborate with healthcare professionals, and implement effective solutions. With a commitment to workplace flexibility and a comprehensive benefits package, this position offers the chance to make a significant impact in the healthcare sector while enjoying a balanced work-life environment.

Benefits

Health Insurance

401K

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 2+ years of experience in Quality Improvement and 3+ years in Managed Care.
• Must hold an active unrestricted Illinois RN licensure.

Responsibilities

• Support quality improvement interventions and audits.
• Monitor quality of care concerns and provider complaints.

Skills

Quality Improvement

Data Analytics

Regulatory Compliance

Problem Solving

Education

High School Diploma or GED

Bachelor's Degree in Healthcare or related field

Job description

Join to apply for the Quality Improvement Specialist role at Meridian of Illinois.

1 week ago Be among the first 25 applicants.

Join to apply for the Quality Improvement Specialist role at Meridian of Illinois.

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.

THIS POSITION IS REMOTE/WORK FROM HOME. APPLICANTS MUST RESIDE IN THE STATE OF ILLINOIS AND HOLD AN ACTIVE UNRESTRICTED ILLINOIS RN LICENSURE.

THE WORK SCHEDULE WILL BE MONDAY - FRIDAY 8AM - 5PM CENTRAL TIME ZONE.

Supports the development and implementation of quality improvement interventions and audits, and assists in resolving deficiencies impacting plan compliance with regulatory and accreditation standards. Interfaces with a diverse range of clinical and administrative professionals, resolves complex issues, and performs data analytics and reporting activities.

1. Monitors and investigates all quality of care concerns and collaborates with medical director to determine impact and next steps for actions.
2. Monitors provider quality complaints to identify trends and educational opportunities for improvement.
3. Monitors quality improvement initiatives, including development and implementation of preventive health and chronic disease outcome improvement interventions such as newsletter articles, member education and outreach, provider education, medical record reviews, focus groups, and surveys.
4. Analyzes, updates, and modifies procedures and processes to continually improve QI operations.
5. Collects and summarizes performance data, identifying opportunities for improvement.
6. Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation, and regulatory requirements are met.
7. Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA, EQRO).
8. Conducts internal audits of compliance with regulatory and accreditation standards.
9. Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.
10. Participates in various QI committees and work groups to improve processes and health outcomes, contributing meaningful detail based on functional knowledge.
11. Completes follow-up as assigned.
12. Manages and monitors assigned quality studies.
13. Investigates and incorporates national best practice interventions to improve rates.
14. Ensures documentation complies with state regulations and accrediting body requirements.
15. Ensures contract/regulatory report content is accurate and submitted on time.
16. Performs other duties as assigned.

Additional Responsibilities

• Completes Licensed Health Care Risk Management certification program.
• Performs annual updates on the Plan Risk Management Program Description.
• Coordinates systematic review of potential adverse incidents per state law.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience

A High School diploma or GED with a current unrestricted RN license. A Bachelor's Degree in Healthcare, Nursing, Health Administration, Public Health, or related health field is preferred.

Work Experience

• 2+ years of experience in Quality Improvement required.
• 3+ years of experience in Managed Care required.
• Experience in Compliance and Accreditation required.

Licenses and Certifications

A license in one of the following is required: Licensed Registered Nurse (RN).

Pay Range

$55,100.00 - $99,000.00 per year.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements. Actual pay will depend on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.