Quality of Care Coordinator

Centene Corporation

2d•$34 - $61•Remote

About The Position

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. This is a remote position open to candidates located in Missouri. The ideal candidate will bring a combination of experience from an acute care setting along with healthcare quality and/or risk management experience. Position Purpose: Review medical records for potential Quality of Care (QOC) incidents, applying clinical criteria to determine if a lack of care was present. Utilize clinical knowledge to provide summary of findings and severity level to physicians. Review medical records for quality of care incidents by determining if the specified standards of care were met, and assigning an initial severity level of lack of compliance/care Compile timeline and summary of incident, including the details of the potential QOC for presentation to the medical director for a final review; may also be involved in peer review committee actions or next steps Maintains organizational and program policies and procedures; ensures adherence to prescribed policies and procedures and clinical protocols where appropriate

Requirements

Associate’s degree in Nursing required; Bachelor’s degree in Nursing preferred.
3+ years of experience in nursing or related healthcare experience.
RN/LCSW required

Nice To Haves

CPHQ preferred

Responsibilities

Review medical records for potential Quality of Care (QOC) incidents, applying clinical criteria to determine if a lack of care was present.
Utilize clinical knowledge to provide summary of findings and severity level to physicians.
Review medical records for quality of care incidents by determining if the specified standards of care were met, and assigning an initial severity level of lack of compliance/care
Compile timeline and summary of incident, including the details of the potential QOC for presentation to the medical director for a final review; may also be involved in peer review committee actions or next steps
Maintains organizational and program policies and procedures; ensures adherence to prescribed policies and procedures and clinical protocols where appropriate