质量改进协调员 II
Quality Improvement Coordinator II
你可能是为我们的2800万会员带来改变的人。Centene正在逐人改善社区的健康状况。作为一家多元化、全国性的组织，你将享受到包括工作灵活性在内的有竞争力的福利。
优先考虑具有Abstractions和Overread经验的候选人。
优先考虑具有MedSurge经验的候选人。
职位目的：
对委托实体进行合规性审查，包括质量、服务绩效和使用情况、资质审查和医疗记录审计。执行与临床计划相关的社区活动，如健康博览会，并与机构和提供者沟通。
· 对委托实体、医生办公室/诊所进行现场质量审查，解决质量问题，生成书面审查结果总结，并根据医学主任和/或资质与质量改进委员会（QIC）的指示进行后续跟进。
· 记录、调查并解决与护理质量相关的事正式和非正式投诉、风险管理及关键事件。
· 审核医疗记录，审查行政索赔并分析数据和干预措施，用于质量改进研究和活动。
· 作为社区资源/机构与公司之间有关临床计划和技术指导的主要联络人。
· 根据合同安排与委托实体召开会议。
· 收集数据并编制各种使用情况和质量改进报告。
· 制定并实施纠正行动计划。
· 建议对质量改进政策和程序进行更改/改进。
· 识别最佳实践，研究新流程并建议项目改进。
· 协调QIC活动和月度会议。
· 监督委托实体的数据提交合同条款的执行。
- 参与报告和数据结果报告的开发。
- 执行其他指派的任务
- 遵守所有政策和标准
- 教育/经验：
- 护理学士学位优先。3年以上临床、质量改进或医疗经验。在医疗环境中2年以上质量相关工作经验。
执照/认证：优先考虑LPN、LVN、RN、PA或LCSW执照。优先考虑CPHQ（医疗质量专业认证）。
薪资范围：每小时33.71 - 60.67美元
Centene提供全面的福利包，包括有竞争力的薪酬、医疗保险、
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You could be the one who changes everything for our 28 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.
Abstractions and Overread experience highly preferred.
MedSurge experience highly preferred.
Position Purpose:
Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers.
· Perform quality on site reviews of delegated entities, physician office/clinics, resolve quality issues, generate written summary of findings and follow up as directed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC).
· Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care issues.
· Audit medical records, review administrative claims and analyze data and interventions for quality improvement studies and activities
· Function as the primary liaison between community resources/agencies and the company related to clinical initiatives and technical guidance.
· Schedule and chair meetings with delegated entities in accordance with their contract.
· Gather data and compile various utilization and quality improvement reports.
· Develop and implement Corrective Action Plans.
· Recommend changes/enhancements to the Quality Improvement policies and procedures.
· Identify best practices, research new processes and recommend program enhancements.
· Coordinate QIC activities and monthly meetings.
· Oversee the enforcement of contract terms regarding data submission for delegated entities.
- Participate in the development of reporting and data outcome reports.
- Performs other duties as assigned
- Complies with all policies and standards
- Education/Experience:
- Bachelor’s degree in Nursing preferred. 3+ years of clinical, quality improvement or healthcare experience. 2+ 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.
Pay Range: $33.71 - $60.67 per hourCentene 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
Originally posted on Himalayas