Quality Improvement Specialist (HEDIS) IRR & Overreads

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.
 

** Role focuses on Inter-Rater Reliability ( IRR) or Secondary Overreads for HEDIS. **

Position Purpose: Support the development and maintenance of quality improvement related projects specific to HEDIS Hybrid Operations. The position exists to support the health plans in the clinical aspect of medical record review.

• 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

Education/Experience: Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience. Experience in HEDIS or NCQA or related topics preferred.

License/Certification: Valid state clinical license preferred (i.e.- LPN, RN, etc.).
 

Preferred Experience: Excel knowledge, HEDIS or NCQA, and prior experience with Abstractions or overreads / secondary overreads (IRR).

Pay Range: $55,100.00 - $99,000.00 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