Quality Improvement Specialist – HEDIS II

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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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

• Take a lead role in developing and maintaining quality improvement projects specific to HEDIS Hybrid Operations • Serve as primary owner for assigned HEDIS measures • Train providers, health plans, and staff in continuous quality improvement methodologies and tools, HEDIS abstraction, and over-read processes • Provide clinical support to medical record abstraction, over-read, and audit processes • Monitor performance on established contractual quality indicators • Analyze, track, and trend results • Prepare for and participate in meetings with committees, state agencies, providers, health plans, vendors, and stakeholders • Recommend, develop, and implement quality performance improvement plans (PIPs) with management using the PDSA model • Monitor and report PIP progress through closure • Conduct year-round pseudo-claims performance, gap identification, and intervention and strategy planning for assigned HEDIS measures • Support department leadership in project and strategy development • Lead complex or high-risk HEDIS quality improvement initiatives with market-wide impact • Provide guidance on complex abstraction scenarios, team training, measure interpretation, abstraction standards, and quality improvement best practices • Mentor and serve as a resource to team members • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience • Requires 2+ years of experience in Quality • Knowledge of HEDIS & performance measures strongly preferred • Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Advanced proficiency across all phases of clinical medical record abstraction, including data entry, over read, and inter-rater reliability (IRR/third level over read) • Functional and technical knowledge regarding overall program requirements and operations • Critical clinical abstraction knowledge for guidance on complex abstraction scenarios, team training, and measure interpretation

🏖️ Benefits

• competitive pay • health insurance • 401K • 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