Quality Reporting Specialist [United States]

 

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You could be the one who changes everything for our 26 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.

Position Purpose: Organize and assemble various quality indicators which are reported to the Quality Management Risk Management Committee. Coordinate Quality of Care (QOC) tracking process and the operational department reporting to ensure timely submission to the payors.

• Prepare Quality Improvement (QI) reports and submit for review prior to submission.
• Track incident, accident, and death (IAD) reports and correspond to QOC investigations to ensure resolution meets the timeliness standards and ensure appropriate information is provided the payor.
• Organize and assemble IAD and QOC data for the QM Committee, the Credentialing Committee, and other entities.
• Ensure that all departments submit reports timely to the payors.
• Participate in the Risk Committee or other appropriate committees as designated.
• Conduct audits of the State IAD-QOC database to ensure data integrity and timeliness of portal submissions.
• Prepare provider financial sanctions for review prior to submission.
• Serve as primary point of contact to resolve provider issues regarding IADs and QOCs.

Education/Experience: High school diploma or equivalent. 2+ years of experience in a health care setting that includes coordination of member care through physicians, clinical nurses and office managers. In depth knowledge of medical/mental health terminology required. For the Illinois Health Plan only: Travel throughout the State to Provider locations may be required; a valid driver’s license and personal transportation will be required.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

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