Quality Improvement Specialist (Clinical)

Centene; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

Centene is seeking a Quality Improvement Specialist to support quality improvement projects and reporting. The role requires a Bachelor's degree and several years of experience in quality improvement, particularly in behavioral and physical health settings. Candidates should possess relevant clinical licenses and a strong background in healthcare quality metrics like HEDIS.

Benefits

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Qualifications

• 3+ years of quality improvement experience in behavioral health.
• 1+ years of quality improvement experience in physical health preferred.
• Active clinical license required (LCSW, LMFT, LPC, LISAC, LMHC, RN).

Responsibilities

• Monitor performance on established contractual quality indicators.
• Develop and implement quality performance improvement plans.
• Train providers and staff in methodologies of continuous quality improvement.

Skills

Quality Improvement

HEDIS Data Analysis

Project Management

Continuous Quality Improvement

Microsoft Office Proficiency

Education

Bachelor's Degree in related field

Master's Degree (preferred)

Job description

Quality Improvement Specialist (Clinical)

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.

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.

Position Purpose: Support the development and maintenance of quality improvement related projects and reporting.

• Monitor performance on established contractual quality indicators. Analyze, track and trend results. Prepare formal written reports for the Quality Management Committee and Executive Management.
• Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model. Monitor and report PIPs progress through closure.
• Train providers and staff in methodologies and tools of continuous quality improvement.
• Prepare for and participate in meetings with various committees, State agencies, providers, and stakeholders.
• Provide clinical support to the medical record audit processes.

Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years of quality improvement experience in a behavioral health setting. 1+ years of quality improvement experience in a physical health setting or completion of Cenpatico Physical Health Workforce Development modules within 6 months of hire will the requirement for physical health experience. Master's degree preferred.

License/Certificates: Licensed Clinical Social Worker (LCSW), Licensed Marriage & Family Therapist (LMFT), Licensed Professional Counselor (LPC), Licensed Independent Substance Abuse Counselor (LISAC), Licensed Medical Health Counselor (LMHC), or a Registered Nurse (RN) required. Certified Professional in Health Care Quality preferred. Current state driver’s license.

Preferred Qualifications:

• Active Registered Nurse (RN) license with compact state licensure

• 5+ years of experience managing, analyzing, and reporting HEDIS data within a health insurance organization

• Proven accountability for report generation management or project management

• Intermediate to expert-level proficiency in Microsoft Office applications

• Experience with quality initiatives, including HEDIS projects, study analysis, SQL, or familiarity with NCQA standards

• Must reside in the Central Time Zone (CST) and be available to work Monday through Friday, 8:00 AM – 5:00 PM CST

Pay Range: $26.50 - $47.59 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, and 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

About the company

Centene Corporation is a publicly traded managed care company based in St.

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