Quality Improvement Coordinator II Job at Centene Corporation, Phoenix, AZ

TmdOK29pak5zbXVlMUdwV1R3L2xKMkVXWGc9PQ==
  • Centene Corporation
  • Phoenix, AZ

Job Description

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

Job Tags

Hourly pay, Contract work, Work at office, Remote work, Flexible hours,

Similar Jobs

Travel Nurses, Inc.

Registered Nurse (RN) - Post Anesthesia/Recovery Room (PACU/RR) Job at Travel Nurses, Inc.

 ...Description We are looking for Post Anesthesia/Recovery Room (PACU/RR) Registered Nurse (RN) for an immediate opening in Novato, California. You...  ...to be flexible and adaptable in new environments. Travel Nurses, Inc. (TNI) offers our traveling nurses excellent benefit... 

TEKsystems

Lead Data Scientist Job at TEKsystems

Job descriptionResponsibilities: - Lead end-to-end data science initiatives, from ideation to deployment, delivering measurable business impact through projects such as feed personalization, product recommendation systems, computer vision and GenAI. - Collaborate cross... 

Caffall Dental Care

Dental Office Manager Job at Caffall Dental Care

 ...Job Title: Dental Office Manager About Us: We're a family-owned practice focused on general dentistry and committed to providing exceptional care. Our mission is to help our patient retain their teeth for life whenever possible. We follow a set of core values that... 

Harbin Ford

Automotive Service Pickup and Delivery Driver-Part Time Job at Harbin Ford

 ...cut above the rest with our unrelenting commitment to customer service. Our associates are our most valuable resource and growth is encouraged...  ...transportation to and from work every single day* Valid driver's license and clean driving record We are an equal... 

The University of Mississippi

Director and Associate/Full Professor Job at The University of Mississippi

 ...preference for candidates who meet the criteria for Associate or Full Professor) offers an exciting opportunity to lead a well-...  ...Workplaces. Touted as the Cultural Mecca of the South, creativity abounds in Oxford as musicians, artists and writers alike find...