Quality Improvement Coordinator II

Centene
Wisconsin
Workplace: RemoteFull timeUSD 33.71 - 60.67 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 2+ yearsEducation: bachelorsSkills: ["Communication","Liaison","Investigation","Quality improvement","Data analysis"]

Conduct compliance, quality, and utilization reviews for delegated entities, including on-site assessments of physician offices/clinics, medical record audits, and analysis of administrative claims. Investigate and resolve complaints and quality-of-care issues, develop Corrective Action Plans, and support QIC activities and monthly meetings. Serve as a liaison between community agencies/resources and the company for clinical initiatives, while preparing utilization and quality improvement reports under the direction of the Medical Director.

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FursaFursa
Centene
Centene
1 day ago

Quality Improvement Coordinator II

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Last checked: 1 day agoStatus: Live

Job Summary

Conduct compliance, quality, and utilization reviews for delegated entities, including on-site assessments of physician offices/clinics, medical record audits, and analysis of administrative claims. Investigate and resolve complaints and quality-of-care issues, develop Corrective Action Plans, and support QIC activities and monthly meetings. Serve as a liaison between community agencies/resources and the company for clinical initiatives, while preparing utilization and quality improvement reports under the direction of the Medical Director.
Location: Wisconsin
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Conduct review of delegated entities for compliance with quality, service performance, utilization, credentialing, and medical record audits.
  • •Perform on-site quality reviews, resolve quality issues, document findings, and follow up as directed by the Medical Director and/or QIC.
  • •Document, investigate, and resolve formal and informal complaints, including risk management and sentinel events related to quality of care.
  • •Audit medical records and analyze data and interventions to support quality improvement studies and activities.
  • •Develop and implement Corrective Action Plans; coordinate QIC activities and reporting for delegated entities.

Pay and Benefits

Salary: USD 33.71 - 60.67 hourly
Perks:Health Insurance401kEquityPaid LeaveHolidays

Key Requirements

  • •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.
Experience:2+ yearsHealthcare
Education:Bachelor's
Skills:CommunicationLiaisonInvestigationQuality improvementData analysis
Licenses:LPNLVNRNPALCSW
Certifications:CPHQ

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn