Supervisor, Quality Improvement

You 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: Oversee the day-to-day quality review function, ensuring accurate and timely review of department processes to ensure compliance with applicable state, federal and accrediting body requirements.

• Provide supervision for appeals and grievance, quality of care/service; provider redeterminations and other applicable department activities including policies, procedures, workflows, letters, and reports.
• Communicate and reinforce standards for the quality team.
• Prepare any applicable department state, federal, or accrediting body reports and submit timely.
• Prepare other quality review reports on departmental findings, identifying individual and organizational trends.
• Identify and analyze team performance trends, address barriers, and recommend process improvements.
• Ensure non-clinical and clinical audits are conducted according to established tools and standards.
• Provide recommendations for development, or revision of policies, procedures, work flows, documents or other documents to be used for training content or skill acquisition.
• Research and respond to complex quality of care or quality of service, appeal and grievance or provider redetermination inquiries.
• Coordinate with management to ensure the department output is meeting goals, expectations and requirements in alignment with the quality improvement department and program description and work plans.

Education/Experience: LPN/LVN or graduate from an Accredited School of Nursing and RN License. Bachelor’s degree in related field preferred.5+ years of clinical experience in health care. Managed care experience preferred. Previous experience in supervisory role, quality assurance preferred. Strong computer skills, including experience with Microsoft office and/or quality monitoring systems.
 

Pay Range: $68,700.00 - $123,700.00 per year

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