Centene (Parent Company) offers affordable and high-quality products to nearly 1 in 15 individuals across the nation, including Medicaid and Medicare members (including the Medicare Prescription Drug Plan) as well as individuals served by the Health Insurance Marketplace and the TRICARE program. Serves over 25+ million members globally and is growing into a Fortune 30 company.

Meridian Health (Centene Company) - We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in three different states (Michigan, Illinois, and Ohio).

Essential Functions:

• Monitors quality improvement initiatives including, but not limited to, development and implementation of preventive health and chronic disease outcome improvement interventions such as: newsletter articles, member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys.
• Monitors and investigates all quality of care and collaborates with medical directors to determine impacts and next steps for actions. Monitors provider quality complaints to identify trends and educational opportunities for improvement.
• Analyzes, updates, and modifies procedures and processes to continually improve QI operations.
• Collects and summarizes performance data and identifies opportunities for improvement.
• Serves as knowledge expert for continuous quality improvement activities, QIPS, PIPs and QIAs.
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO).
• Conducts internal auditing of compliance with regulatory and accreditation standards.
• Supports the implementation of the quality reporting infrastructure.
• Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.
• Assists in activities to prioritize clinical and service improvement initiatives.
• Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail, based on functional knowledge. Completes follow-up as assigned.
• Manages and monitors assigned quality studies.
• Investigates and incorporates national best practice interventions to affect greater rate increases.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.

Candidate Education:

• Required A High School or GED with a current unrestricted RN license
• Preferred A Bachelor's Degree in Healthcare, Nursing, Health Administration, Public Health or related health field

Candidate Experience:

• Required 2 years of experience in Quality Improvement
• Required 3 years of experience in Managed Care
• Required Other Experience in compliance and accreditation
• Required Other Knowledge of federal and state regulations/requirements

All your information will be kept confidential according to EEO guidelines.