Quality of Care Coordinator

Oklahoma Complete Health works to transform the health of our communities, one person at a time, through SoonerSelect and the SoonerSelect Specialty Children’s Plan. Oklahoma Complete Health exists to improve the health of our members through focused, compassionate and coordinated care delivered locally. Through services such as enhanced vision coverage, programs for pregnant and new moms, rewards for healthy behaviors, and so much more, Oklahoma Complete Health is a new managed Medicaid care plan supporting not only our members’ medical coverage but also their complete health. Our mission is to deliver healthcare solutions to our communities every day. Our employees are driven to make a difference and ready to make an impact.

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. **Applicants for this position have the flexibility to work remotely from their home anywhere in the US. Candidates must possess an Oklahoma RN license or a compact RN license. The work schedule will be Monday - Friday, 8am - 5pm Central.** Position Purpose: Review medical records for potential Quality of Care (QOC) incidents, applying clinical criteria to determine if a lack of care was present. Utilize clinical knowledge to provide summary of findings and severity level to physicians.

Review medical records for quality of care incidents by determining if the specified standards of care were met, and assigning an initial severity level of lack of compliance/care Compile timeline and summary of incident, including the details of the potential QOC for presentation to the medical director for a final review; may also be involved in peer review committee actions or next steps Maintains organizational and program policies and procedures; ensures adherence to prescribed policies and procedures and clinical protocols where appropriate