[Remote] Quality Improvement Specialist (HEDIS) IRR & Overreads

Note: The job is a remote job and is open to candidates in USA. Centene Corporation is transforming the health of communities, focusing on individual member needs. The Quality Improvement Specialist role is dedicated to supporting quality improvement projects related to HEDIS, providing clinical support, training, and monitoring performance indicators. Responsibilities • Train providers, health plans and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes • Provide clinical support to the medical record abstraction, over-read and audit processes • Monitor performance on established contractual quality indicators. • Analyze, track and trend results • Prepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholders • Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model. • Monitor and report PIPs progress through closure. • Performs other duties as assigned • Complies with all policies and standards Skills • Experience in HEDIS or NCQA or related topics. • Train providers, health plans and staff in methodologies and tools of continuous quality improvement and HEDIS abstraction and over-read processes. • Provide clinical support to the medical record abstraction, over-read and audit processes. • Monitor performance on established contractual quality indicators. • Analyze, track and trend results. • Prepare for and participate in meetings with various committees, state agencies, providers, health plans, vendors, and stakeholders. • Recommend, develop, and implement quality performance improvement plans (PIPs) with management utilizing the PDSA model. • Monitor and report PIPs progress through closure. • Complies with all policies and standards. • Experience in HEDIS or NCQA or related topics. • Valid state clinical license preferred (i.e.- LPN, RN, etc.). • Excel knowledge. • Prior experience with Abstractions or overreads / secondary overreads (IRR). Education Requirements • Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience. Benefits • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules Company Overview • Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. It was founded in 1984, and is headquartered in Saint Louis, MO, US, with a workforce of 10001+ employees. Its website is http://www.centene.com. Company H1B Sponsorship • Centene Corporation has a track record of offering H1B sponsorships, with 1 in 2021. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply To this Job