Quality Improvement Specialist – HEDIS

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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

• Support the development and maintenance of quality improvement projects specific to HEDIS Hybrid Operations • Support health plans in the clinical aspect of medical record review • Train providers, health plans, and staff in continuous quality improvement methodologies and tools • Train providers, health plans, and staff in 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 using the PDSA model • Monitor and report PIP progress through closure • 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 • Valid state clinical license preferred, such as LPN or RN • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Knowledge of HEDIS measures or NCQA • Experience in related healthcare may substitute for the stated degree

🏖️ 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