Quality Improvement Coordinator – Behavioral Health

Job not on LinkedIn

🔥 0 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $33 - $60 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations • Lead clinical quality initiatives • Review clinical information for appeals to determine medical necessity of services • Prepare reviews and cases for appeals and fair hearings • Develop and implement the behavioral health quality program description, work plan goals, HEDIS measures and program evaluation documents • Lead Behavioral Health Performance Improvement Projects (PIPs) • Maintain files, logs and documentation, including communications, in accordance with NCQA and State standards and regulations • Investigate and resolve behavioral health quality of care complaints and grievances • Act as liaison for appeals and fair hearings • Perform other duties as assigned

🎯 Requirements

• Associate's Degree in Nursing or other related field of study required • 2+ years in Clinical Nursing or Behavioral Health required • 1+ years experience in Quality, Managed Care or Healthcare Administration required • Experience in Behavioral Healthcare field preferred • Registered Nurse (RN) certification, Licensed Mental Health Professional (LMHC), or Licensed Professional Counselor (LPC) required • Compliance with NCQA and State standards and regulations, including timelines • Must comply with all policies and standards

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation