Quality Improvement Specialist (HEDIS)

Oklahoma Complete Health; Washington (District of Columbia); Remote; USD 55,000 - 99,000; Full time

Job summary

Oklahoma Complete Health is seeking a Quality Improvement Specialist to support health plans in clinical aspects of record review and quality improvement initiatives. The candidate will be responsible for training staff on HEDIS practices and monitoring performance indicators. This full-time position offers competitive pay and a comprehensive benefits package, emphasizing community health and quality care.

Benefits

Comprehensive benefits package

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• Licensed LPN or RN or significant HEDIS experience.
• Experience in training and quality improvement.
• Strong analytical skills to monitor performance indicators.

Responsibilities

• Support quality improvement projects related to HEDIS.
• Train staff in quality improvement methodologies.
• Analyze and report on quality indicators and PIPs.

Skills

Quality improvement methodologies

Clinical support

HEDIS abstraction processes

Education

Licensed LPN or RN

10+ years of HEDIS experience

Job description

1 week ago Be among the first 25 applicants

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 specific to HEDIS Hybrid Operations. The position exists to support the health plans in the clinical aspect of medical record review.

• Train providers, health plans and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes
• Provide clinical support to the medical record abstraction, over-read and audit processes
• Monitor performance on established contractual quality indicators.
• Analyze, track and trend results
• Prepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholders
• Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model.
• Monitor and report PIPs progress through closure.
• Performs other duties as assigned
• Complies with all policies and standards
  
  

Education/Experience Licensed LPN or RN, or 10+ years of HEDIS experience.

Pay Range $55,100.00 - $99,000.00 per year

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. Total compensation may also include additional forms of incentives.

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

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Hospitals and Health Care and Insurance

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