Quality Improvement Specialist II

Centene; United States; Remote; USD 55,000 - 99,000; Full time

Job summary

Join Centene as a Quality Improvement Specialist, supporting operations through data management, analysis, and project oversight. You will manage projects related to quality initiatives, ensuring accuracy in reporting and compliance with regulatory standards, all while contributing positively to community health. This role allows for flexibility and offers competitive benefits.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• 4+ years of data management experience in health insurance.
• Highly preferred: CPHQ certification.
• Strong project management experience.

Responsibilities

• Manage the HEDIS project and vendor oversight.
• Assist in data collection and reporting for QI initiatives.
• Conduct audits and ensure data integrity.

Skills

Project Management

Data Management

Analysis

Education

Associate's degree in related field

Tools

MS Office

Job description

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.

Must reside in GA

Position Purpose: Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management.

• Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
• Assist in data collection, data entry and generation of reports in support of QI initiatives including but not limited to: access and availability studies, HEDIS abstraction forms, medical records/site reviews, member and physician satisfaction studies
• Analyze data and report writing for committee discussion
• Research and write items for provider newsletters and other educational pieces
• Conduct Interdepartmental inter-rater reliability audits\
• Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
• Implement process improvements to streamline departmental functions
• Assists Director, QI in preparation for audits by regulatory agencies and review organizations
• Performs other duties as assigned
• Complies with all policies and standards

Must reside is GA

Education/Experience: Associate’s degree in related field or equivalent experience. 4+ years of data management experience, with a health insurance organization, in a position with accountability for report generation management or project management. Working knowledge of MS Office applications. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.

CPHQ highly preferred

Strong Project Management experience highly preferred

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

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.

Must reside in GA

Position Purpose: Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management.

• Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
• Assist in data collection, data entry and generation of reports in support of QI initiatives including but not limited to: access and availability studies, HEDIS abstraction forms, medical records/site reviews, member and physician satisfaction studies
• Analyze data and report writing for committee discussion
• Research and write items for provider newsletters and other educational pieces
• Conduct Interdepartmental inter-rater reliability audits\
• Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
• Implement process improvements to streamline departmental functions
• Assists Director, QI in preparation for audits by regulatory agencies and review organizations
• Performs other duties as assigned
• Complies with all policies and standards

Must reside is GA

Education/Experience: Associate’s degree in related field or equivalent experience. 4+ years of data management experience, with a health insurance organization, in a position with accountability for report generation management or project management. Working knowledge of MS Office applications. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.

CPHQ highly preferred

Strong Project Management experience highly preferred

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

About the company

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

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