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Quality Improvement Coordinator II

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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.

Position Purpose:
Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers.

Perform quality on site reviews of delegated entities, physician office/clinics, resolve quality issues, generate written summary of findings and follow up as directed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC).

Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care issues.

Audit medical records, review administrative claims and analyze data and interventions for quality improvement studies and activities

Function as the primary liaison between community resources/agencies and the company related to clinical initiatives and technical guidance.

Schedule and chair meetings with delegated entities in accordance with their contract.

Gather data and compile various utilization and quality improvement reports.

Develop and implement Corrective Action Plans.

Recommend changes/enhancements to the Quality Improvement policies and procedures.

Identify best practices, research new processes and recommend program enhancements.

Coordinate QIC activities and monthly meetings.

Oversee the enforcement of contract terms regarding data submission for delegated entities.

Participate in the development of reporting and data outcome reports.
Performs other duties as assigned

Complies with all policies and standards

Education/Experience:
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.

License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. CPHQ (Certified Professional in Healthcare Quality) preferred.

Pay Range: $33.03 - $59.47 per hour

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

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CEO of Centene

Sarah London

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Average salary estimate

$96243.5 / YEARLY (est.)

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$68627K

$123860K

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What You Should Know About Quality Improvement Coordinator II, Centene

Are you ready to make a big impact in healthcare? As a Quality Improvement Coordinator II at Centene, you will play a crucial role in improving the care provided to our 28 million members while enjoying the benefits of a flexible remote work environment. In this position, you'll conduct thorough reviews of our delegated entities to ensure compliance with quality standards, service performance, and utilization, making a significant difference in the quality of care our members receive. You’ll also have the opportunity to engage with the community by collaborating on health initiatives, organizing quality reviews at clinics, and handling various quality improvement activities. Whether you’re investigating complaints or auditing medical records, each task you undertake will contribute toward enhancing the overall quality of care. You're not just a part of a company; you're part of a mission to transform health in our communities. Join Centene and bring your experience in clinical or healthcare quality improvement to the forefront while benefiting from competitive pay, robust health insurance, and a variety of professional development opportunities. Together, we can change lives, one community at a time.

Frequently Asked Questions (FAQs) for Quality Improvement Coordinator II Role at Centene

What are the primary responsibilities of a Quality Improvement Coordinator II at Centene?

The Quality Improvement Coordinator II at Centene is primarily responsible for conducting compliance reviews of delegated entities, performing quality audits, and resolving complaints related to care quality. This role also involves supervising community activities, gathering data, coordinating meetings, and developing corrective action plans to improve healthcare quality.