Quality Improvement HEDIS - LPN

Arizona Complete Health offers health insurance plans that fit the unique needs of our members. AzCH proudly serves Arizonans through Medicare, Marketplace & Medicaid health plans.

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. Position Purpose: Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. This is a 100% remote position, candidate must reside in Arizona.

Perform quality on site reviews of delegated entities, physician office/clinics, resolve quality issues, generate written summary of findings and follow up as directed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC). Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care issues. Audit medical records, review administrative claims and analyze data and interventions for quality improvement studies and activities Function as the primary liaison between community resources/agencies and the company related to clinical initiatives and technical guidance. Schedule and chair meetings with delegated entities in accordance with their contract. Gather data and compile various utilization and quality improvement reports. Develop and implement Corrective Action Plans. Recommend changes/enhancements to the Quality Improvement policies and procedures. Identify best practices, research new processes and recommend program enhancements. Coordinate QIC activities and monthly meetings. Oversee the enforcement of contract terms regarding data submission for delegated entities. Participate in the development of reporting and data outcome reports. Performs other duties as assigned Complies with all policies and standards