Quality Improvement Specialist (HEDIS)

Centene Corporation•Remote-OK, OK

2d•$56,200 - $101,000•Hybrid

About The Position

Support the development and maintenance of quality improvement related projects specific to HEDIS Hybrid Operations. The position exists to support the health plans in the clinical aspect of medical record review. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT
Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience.

Nice To Haves

Valid state clinical license preferred (i.e.- LPN, RN, etc.)

Responsibilities

Train providers, health plans and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes
Provide clinical support to the 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 various committees, state agencies, providers, health plans, vendors, and stakeholders
Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model.
Monitor and report PIPs progress through closure.
Performs other duties as assigned
Complies with all policies and standards