Remote-Eligible Quality Improvement Specialist

Centene Corporation; Yuma (AZ); 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 plus holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a quality improvement professional to review delegated entities for compliance with quality, service performance and utilization, and perform credentialing reviews and medical record audits. The role includes on-site reviews of physician offices, documenting findings, and coordinating follow-up with the Medical Director and QIC.

The candidate will investigate complaints, analyze data for quality improvement and develop corrective action plans, coordinating with

Qualifications

• Bachelor’s degree in Nursing preferred.
• 3+ years of clinical, quality improvement or healthcare experience.
• 2+ years of experience in quality function in a healthcare setting.
• LPN, LVN, RN, PA, or LCSW license preferred.
• CPHQ (Certified Professional in Healthcare Quality) preferred.

Responsibilities

• Review delegated entities for quality, service performance, utilization, credentialing reviews, and medical record audits.
• Conduct on-site quality reviews of delegated entities and physician offices; document findings and follow-up actions.
• Investigate and resolve formal and informal complaints, risk management issues and sentinel events related to quality of care.

Skills

Quality improvement

Healthcare quality

Clinical experience

Regulatory compliance

Education

Bachelor's degree in Nursing

Job description

Centene Corporation seeks a quality improvement professional to review delegated entities for compliance with quality, service performance and utilization, and perform credentialing reviews and medical record audits. The role includes on-site reviews of physician offices, documenting findings, and coordinating follow-up with the Medical Director and QIC.

The candidate will investigate complaints, analyze data for quality improvement and develop corrective action plans, coordinating with