Clinical Quality Coordinator (RN)

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 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 required1+ years Case management or quality improvement in a managed care setting requiredExperience in a government sponsored managed care program preferredRN - Registered Nurse - State Licensure and/or Compact State Licensure requiredTrucare 0experience highly preferredPay Range: $54,000.00 - $97,100.00 per yearCentene 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. Total compensation may also include additional forms of incentives.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