[Hiring] Quality Improvement Specialist II @Centene Corporation

Role Description

Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management.

• Remote position; candidates must reside in Nevada or Arizona.
• Preferred qualifications include experience with Managed Care Organizations (MCO), Quality Management/Improvement, and HEDIS.
• Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality.
• Assist in data collection, data entry and generation of reports in support of QI initiatives including but not limited to:
  • Access and availability studies
  • HEDIS abstraction forms
  • Medical records/site reviews
  • Member and physician satisfaction studies
• Analyze data and report writing for committee discussion.
• Research and write items for provider newsletters and other educational pieces.
• Conduct Interdepartmental inter-rater reliability audits.
• Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
• Implement process improvements to streamline departmental functions.
• Assist Director, QI in preparation for audits by regulatory agencies and review organizations.
• Perform other duties as assigned.
• Comply with all policies and standards.

Qualifications

• Associate’s degree in related field or equivalent experience.
• 4+ years of data management experience with a health insurance organization, in a position with accountability for report generation management or project management.
• Working knowledge of MS Office applications.
• Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.

Requirements

• Must live in AZ or NV.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.