Quality Improvement Specialist II

Position Purpose: Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management.

Key Details: Remote position; candidates must reside in Nevada or Arizona. Preferred qualifications include experience with Managed Care Organizations (MCO), Quality Management/Improvement, and HEDIS.

• Manage the HEDIS project to include assignment of nurses, adherence to plan timeline, and vendor oversight for timeliness and quality
• Assist in data collection, data entry and generation of reports in support of QI initiatives including but not limited to: access and availability studies, HEDIS abstraction forms, medical records/site reviews, member and physician satisfaction studies
• Analyze data and report writing for committee discussion
• Research and write items for provider newsletters and other educational pieces
• Conduct Interdepartmental inter-rater reliability audits
• Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
• Implement process improvements to streamline departmental functions
• Assists Director, QI in preparation for audits by regulatory agencies and review organizations
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Associate’s degree in related field or equivalent experience. 4+ years of data management experience, with a health insurance organization, in a position with accountability for report generation management or project management. Working knowledge of MS Office applications. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.

Location: Must live in AZ or NV.

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.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act