Remote Clinical Quality Improvement Coordinator II

SilverSummit Healthplan; Nevada; Hybrid; USD 46,000 - 84,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedule: remote, hybrid

Job summary

Centene is seeking a Quality Improvement professional to coordinate and monitor corporate and health plan–level quality initiatives in line with NCQA and URAC standards. The role involves policy development, data collection, and cross-functional project support to drive compliance and program enhancements.

Ideal candidates hold a Nursing degree with 3+ years clinical experience and at least 1 year in a quality function, including policy writing for accreditation readiness.

Qualifications

• Bachelor’s degree in Nursing or related medical field; RN/LPN/LVN preferred.
• 3+ years clinical experience and 1+ year in a quality function.
• Hands-on experience writing and implementing policies to support NCQA/URAC or JCAHO accreditation standards.
• Basic understanding of health insurance business, claims payment procedures, and healthcare trends.

Responsibilities

• Coordinate and monitor quality improvement and organizational projects from inception to closure.
• Assist with plan compliance to NCQA/URAC standards with the Director of Accreditation.
• Maintain Quality Improvement policies and procedures in line with NCQA/URAC requirements.
• Identify best practices and research new processes to enhance programs.
• Support the project life cycle including requirements gathering, project plans, resource management and deployment.
• Assist with data collection and presentation for QI projects; identify data sources and timelines.
• Perform other duties as assigned and comply with all policies.

Skills

Clinical experience

Quality function experience

Policy writing

Education

Bachelor’s degree in Nursing or related medical field

Job description

Centene is seeking a Quality Improvement professional to coordinate and monitor corporate and health plan–level quality initiatives in line with NCQA and URAC standards. The role involves policy development, data collection, and cross-functional project support to drive compliance and program enhancements.

Ideal candidates hold a Nursing degree with 3+ years clinical experience and at least 1 year in a quality function, including policy writing for accreditation readiness.