Remote Behavioral Health Quality Improvement Lead

Centene Corporation; Baton Rouge (LA); Sur place; USD 46 000 - 84 000; Plein temps

Avantages offerts par ce poste

Remote work options

Hybrid work options

Benefits package

Résumé du poste

Centene Corporation is seeking a Quality Improvement Nurse to analyze, develop, and monitor clinical QI activities for compliance with customer expectations and to lead clinical quality initiatives in behavioral health.

The role includes developing program descriptions and goals with HEDIS measures, leading behavioral health PIPS, reviewing medical necessity for appeals, and preparing cases for non-qualifying appeals. Strong NCQA/state compliance and documentation skills are essential.

Qualifications

• Associate's Degree in Nursing or related field required.
• 2+ years in Clinical Nursing or Behavioral Health required.
• 1+ years experience in Quality, Managed Care or Healthcare Administration required.

Responsabilités

• Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives.
• Develop and implement the quality program description and goals including HEDIS measures for behavioral health.
• Lead Behavioral Health Performance Improvement Projects (PIPS).
• Review clinical information for appeals to determine medical necessity and prepare cases for appeals that do not meet medical necessity.
• Maintain files and documentation in accordance with NCQA and state standards and timelines.
• Investigate and resolve behavioral health quality of care complaints and grievances.
• Complies with all policies and standards.

Connaissances

Clinical Nursing

Behavioral Health

Quality Management

Regulatory Compliance

Formation

Associate's Degree in Nursing or related field

Description du poste

Centene Corporation is seeking a Quality Improvement Nurse to analyze, develop, and monitor clinical QI activities for compliance with customer expectations and to lead clinical quality initiatives in behavioral health.

The role includes developing program descriptions and goals with HEDIS measures, leading behavioral health PIPS, reviewing medical necessity for appeals, and preparing cases for non-qualifying appeals. Strong NCQA/state compliance and documentation skills are essential.