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Form of workYou 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.
Position Purpose: Lead Quality Improvement initiatives as the subject matter expert in a variety of areas including utilization management, credentialing reviews and medical audits. Train, develop and organize staff to implement quality initiatives under manager's supervision.
This position is remote, work from home but must reside in South Carolina. We are looking for a LVN/LPN or RN for this position.
- Field questions and escalated issues related to HEDIS and NCQA.
- Monitor team performance.
- Recognize and anticipate issues to report to the Manager.
- Conduct monthly audits to identify trends.
- With the Manager, develop actions for improvement based on identified trends.
- Create reports and presentations for meetings.
- Gather, analyze, and complete reports for Manager for review.
- Review, maintain, update and revise internal Procedures on an ongoing basis.
- Train staff on processes, procedures, and IT systems.
Education/Experience: Bachelor's degree in Nursing preferred. 4+ years of clinical, Quality Improvement or healthcare experience. 3+ years of experience in quality function in a healthcare setting.
License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. CPHQ (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.
