Job description

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

THIS POSITION IS REMOTE/WORK FROM HOME IN PA.

Position Purpose: Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes.

Perform duties and functions to comply with quality improvement programs according to state requirements.
Support Quality Assurance Performance Improvement work plan/initiatives.
Schedule and assist with committee and sub-committee preparation.
Assist in investigation and resolution of member quality of care complaints.
Audit medical records and monitor performance measures for health care risk management, sentinel events and trends.

For PA H&W only:
Responsible for overseeing reporting and outcome measurement and HEDIS data collection, serving as point person between the Department and the Department’s EQR contractor.

Education/Experience: Bachelor’s degree in nursing preferred. 2+ years clinical, quality management or healthcare related experience. At least one year experience in quality function in a healthcare setting.

License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. Utilization management certification preferred. Certified Professional in Healthcare Quality preferred.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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