Quality Improvement Coordinator II

Centene
Washington
Workplace: RemoteFull timeUSD 33.71 - 60.67 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 3+ yearsEducation: bachelorsSkills: []

Coordinate quality reviews for delegated entities, including compliance, service performance, utilization, credentialing, and medical record audits. Conduct on-site quality reviews, resolve quality issues, and produce written findings followed by Medical Director/QIC follow-up. Document and investigate complaints, risk management, and sentinel events; audit records and claims data for quality improvement studies. Serve as a liaison with community resources for clinical initiatives, develop corrective action plans, and coordinate QIC activities and reporting.

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FursaFursa
Centene
Centene
1 day ago

Quality Improvement Coordinator II

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Coordinate quality reviews for delegated entities, including compliance, service performance, utilization, credentialing, and medical record audits. Conduct on-site quality reviews, resolve quality issues, and produce written findings followed by Medical Director/QIC follow-up. Document and investigate complaints, risk management, and sentinel events; audit records and claims data for quality improvement studies. Serve as a liaison with community resources for clinical initiatives, develop corrective action plans, and coordinate QIC activities and reporting.
Location: Washington
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Conduct reviews of delegated entities for compliance, quality, service performance, utilization, credentialing, and medical record audits.
  • •Perform on-site quality reviews, resolve quality issues, and generate written summaries of findings for Medical Director and/or QIC follow-up.
  • •Document, investigate, and resolve formal and informal complaints, risk management, and sentinel events related to quality of care issues.
  • •Audit medical records and administrative claims, analyze data for quality improvement studies, and develop and implement Corrective Action Plans.
  • •Coordinate QIC activities and monthly meetings; serve as a liaison with community resources/agencies for clinical initiatives and communicate technical guidance.
Travel: Low travel

Pay and Benefits

Salary: USD 33.71 - 60.67 hourly
Perks:Health Insurance401kEquityPaid LeavePaid HolidaysRemote Work

Key Requirements

  • •RN licensed in WA state and candidate residing in WA state.
  • •3+ years of clinical, quality improvement, or healthcare experience.
  • •2+ years of experience in quality function in a healthcare setting.
  • •Bachelor’s degree in Nursing preferred.
  • •LPN, LVN, RN, PA, or LCSW license preferred; CPHQ (Certified Professional in Healthcare Quality) preferred.
Experience:3+ yearsHealthcareQuality improvementClinical
Education:Bachelor's
Licenses:RNLPNLVNPALCSW
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