Clinical Quality Coordinator (RN)

Educate members about needed screenings, including diabetic and breast cancer screenings.

Encourage members to schedule appointments and assist with scheduling as needed.

Complete assessments, including the Conditions of Older Adults assessment, to review members’ independence, fall history, and need for physician follow-up.

Adapt to changing outreach campaigns, priorities, and processes.

Work from home in the Eastern or Central time zone.

Approximately 8:00 a.m.–5:00 p.m., with adjustments based on your time zone and business needs.

Position Purpose

Conduct member outreach, provider outreach, and chart review to assess, plan, gather information, and coordinate medical and supporting services across the continuum of care to support both direct and indirect HEDIS care gap closure.

• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary support care gap closure activities.
• Provide patient and provider education
• Facilitate member access to community based services
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Support direct care gap closure of HEDIS measures through member outreach, assessment, and documentation of member status.
• Provide clinical support as needed to outreach coordinators interacting with high-risk members and/or providers to improve healthcare outcomes and close care gaps. Provides support for quality initiatives including outreach to members who are noncompliant in the designated outreach services.
• Maintain a caseload of members to provide education to members/guardians to support improved healthcare outcomes and see them through care gap closure activities, such as childhood immunizations.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience

Bachelor's Degree Nursing required Master's Degree Nursing preferred

2+ years Clinical Nursing in an acute care setting required 1+ years Case management or quality improvement in a managed care setting required Experience in a government sponsored managed care program preferred RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $56,200.00 - $101,000.00 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act