Quality Improvement Specialist

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $56.2k - $101k / 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

• Monitor and investigate quality of care concerns and collaborate with the medical director on impact and next steps • Monitor provider quality complaints to identify trends and educational opportunities • Monitor quality improvement initiatives, including preventive health and chronic disease outcome interventions • Analyze, update, and modify QI procedures and processes • Collect and summarize performance data and identify improvement opportunities • Monitor and analyze outcomes against goals, objectives, accreditation, and regulatory requirements • Participate in regulatory and accreditation site visit preparation and execution • Conduct internal audits for compliance with regulatory and accreditation standards • Trend and report QI work-plan metrics, perform data/barrier analysis, develop recommendations, and deploy approved actions • Participate in QI committees and work groups • Manage and monitor assigned quality studies • Investigate and incorporate national best-practice interventions • Ensure documentation and regulatory report submissions are accurate and timely • Complete follow-up and other assigned duties • Perform annual updates to the Plan Risk Management Program Description • Coordinate systematic review of potential adverse incidents according to state statute • Support quality improvement interventions and audits and resolve deficiencies affecting regulatory and accreditation compliance • Interface with clinical and administrative professionals and perform data analytics and reporting

🎯 Requirements

• Current unrestricted RN license required • High School diploma or GED with a current unrestricted RN license • For Ohana Health Plan only: Associates Degree required and must be a Licensed RN in the state of Hawaii • 2+ years of experience in Quality Improvement required • 3+ years of experience in Managed Care preferred • Experience in compliance and accreditation required • Knowledge of federal and state regulations/requirements required • Completion of Licensed Health Care Risk Management certification program • Ability to monitor, investigate, analyze, audit, report, and improve quality and compliance processes

🏖️ 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 • Diversity-focused equal opportunity workplace