Monitor and ensure compliance related to state reporting, HHS and HPMS memos for quality ratings.
Establish quality check policy/procedures for all member and provider communications to ensure accuracy of information, data, and alignment with Centene business goals.
Establish QPS policies, procedures, and quality checks for all reoccurring departmental programs/activities, to ensure precision execution and accuracy.
Create, maintain and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibility.
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience. Master’s degree preferred. 4+ years of clinical experience, managed care or health insurance experience required; 2+ years of quality experience preferred.
License/Certification: Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW), preferred; CPHQ preferred
Pay Range: $70,100.00 - $126,200.00 per year
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
