Quality Improvement Coordinator II

Centene Corporation•Remote-AZ, AZ

4d•$34 - $61

About The Position

The Quality Improvement Coordinator conducts reviews of delegated entities for compliance with quality, service performance, utilization, and credentialing requirements, and performs medical record audits. The role also supports community activities related to clinical initiatives, such as health fairs, and communicates with agencies and providers. Candidates must live in Arizona. The coordinator serves as a liaison between community resources and the company, coordinates Quality Improvement Committee activities and meetings, and works with delegated entities on quality reviews, reporting, and contract requirements. The position also investigates quality-of-care concerns and helps develop and implement corrective actions and program improvements.

Requirements

At least 3 years of clinical, quality improvement, or healthcare experience.
At least 2 years of experience in a quality function in a healthcare setting.
Must live in Arizona.

Nice To Haves

Bachelor’s degree in Nursing preferred.
LPN, LVN, RN, PA, or LCSW license preferred.
CPHQ (Certified Professional in Healthcare Quality) preferred.

Responsibilities

Perform quality on-site reviews of delegated entities and physician offices or clinics; resolve quality issues, prepare written summaries of findings, and 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 matters, 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.
Serve as the primary liaison between community resources or agencies and the company regarding clinical initiatives and technical guidance.
Schedule and chair meetings with delegated entities in accordance with their contracts.
Gather data and compile utilization and quality improvement reports.
Develop and implement Corrective Action Plans.
Recommend changes or 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 developing reporting and data outcome reports.
Perform other duties as assigned.
Comply with all policies and standards.