Quality Improvement Coordinator II

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $33 - $60 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 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.

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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

• 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 • Communicate with agencies and providers • Perform quality on-site reviews of delegated entities and physician offices/clinics • Resolve quality issues and generate written summaries of findings • 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 utilization and quality improvement reports • Develop and implement Corrective Action Plans • Recommend changes and enhancements to Quality Improvement policies and procedures • Identify best practices, research new processes and recommend program enhancements • Coordinate QIC activities and monthly meetings • Oversee enforcement of contract terms regarding data submission for delegated entities • Participate in development of reporting and data outcome reports • Perform other duties as assigned

🎯 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 • Abstractions and Overread experience highly preferred • MedSurge experience highly preferred • Complies 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