Quality Improvement Coordinator - Behavioral Health

Centene Corporation • Baton Rouge, LA

9d • $34 - $61

About The Position

The Quality Improvement Coordinator – Behavioral Health analyzes, develops, and monitors clinical quality improvement activities to ensure compliance with customer expectations and leads clinical quality initiatives. The role develops and implements the behavioral health quality program description, work plan goals—including applicable HEDIS measures—and program evaluation (trilogy documents). It leads Behavioral Health Performance Improvement Projects (PIPs), reviews clinical information to determine medical necessity for appeals, prepares cases that do not meet medical necessity, and serves as a liaison for appeals and fair hearings. The coordinator maintains files, logs, and documentation, including communications, in accordance with NCQA and state standards, regulations, and timelines. The role also investigates and resolves behavioral health quality-of-care complaints and grievances and performs other duties as assigned.

Centene describes its work as supporting individuals, families, and communities in accessing care and improving health. The company offers a flexible approach to work, with remote, hybrid, field, or office schedules. Pay is $33.71–$60.67 per hour; actual pay may vary based on job-related factors, and total compensation may include incentives. Benefits may depend on program eligibility.

Requirements

• Associate's degree in nursing or another related field of study.
• At least 2 years of experience in clinical nursing or behavioral health.
• At least 1 year of experience in quality, managed care, or healthcare administration.
• Registered Nurse (RN) certification, Licensed Mental Health Counselor (LMHC) license, or Licensed Professional Counselor (LPC) license.

Nice To Haves

• Experience in the behavioral healthcare field.

Responsibilities

• Analyze, develop, and monitor clinical quality improvement activities to ensure compliance with customer expectations.
• Lead clinical quality initiatives.
• Develop and implement the behavioral health quality program description, work plan goals, applicable HEDIS measures, and program evaluation (trilogy documents).
• Lead Behavioral Health Performance Improvement Projects (PIPs).
• Review clinical information for appeals to determine medical necessity.
• Prepare cases for appeals that do not meet medical necessity.
• Act as the liaison for appeals and fair hearings.
• Maintain files, logs, documentation, and communications in accordance with NCQA and state standards, regulations, and timelines.
• Investigate and resolve behavioral health quality-of-care complaints and grievances.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay.
• Health insurance.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Flexible approach to work, with remote, hybrid, field, or office work schedules.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree