Remote Behavioral Health QI Coordinator

Centene Corporation; Bastrop (LA); Hybrid; USD 46,000 - 84,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote, hybrid, field or office work S

Flexible work schedules

Job summary

Centene Corporation is seeking a Clinical Quality Improvement professional in Louisiana to analyze, develop, and monitor behavioral health QI activities and appeals processes. You will lead quality projects, evaluate medical necessity, and prepare appeal cases while ensuring NCQA/state compliance.

This role supports delivering high-quality care and reducing barriers for members. The ideal candidate holds an RN, LMHC, or LPC license with 2+ years in clinical nursing or behavioral health and 1+

Qualifications

• Associate's degree required with 2+ years in Clinical Nursing or Behavioral Health
• 1+ year in Quality, Managed Care, or Healthcare Administration
• RN, LMHC, or LPC license/certification required; Behavioral Healthcare experience preferred

Responsibilities

• Analyze and monitor clinical QI activities to ensure customer expectations are met
• Lead Behavioral Health Performance Improvement Projects (PIPs)
• Review clinical information for appeals to determine medical necessity
• Prepare cases for appeals that do not meet medical necessity
• Maintain NCQA/state compliant files and logs with timelines
• Investigate and resolve behavioral health quality of care complaints and grievances
• Comply with all policies and standards

Skills

Clinical Nursing

Behavioral Health

Quality Management

Healthcare Administration

Liaison/Communication

Education

Associate's Degree in Nursing or related field

Job description

Centene Corporation is seeking a Clinical Quality Improvement professional in Louisiana to analyze, develop, and monitor behavioral health QI activities and appeals processes. You will lead quality projects, evaluate medical necessity, and prepare appeal cases while ensuring NCQA/state compliance.

This role supports delivering high-quality care and reducing barriers for members. The ideal candidate holds an RN, LMHC, or LPC license with 2+ years in clinical nursing or behavioral health and 1+