What are the responsibilities and job description for the Quality Improvement Specialist II position at Envolve Pharmacy Solutions?
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 Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management.
Associate’s degree in related field or equivalent experience.
4 years of data management experience, with a health insurance organization, in a position with accountability for report generation management or project management.
Working knowledge of MS Office applications.
Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.
Pay Range $55,100.00 - $99,000.00 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.
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
Position Purpose Assist with the daily operations and support within the Quality Improvement department including data management, data reporting needs, and project management.
- Complete quality reviews and submissions of Health Plan reports, adherence to plan timelines, and report oversight for timeliness and quality
- Assist in data collection, data entry and delivery of reports in support of QI initiatives including but not limited to access and availability studies, HEDIS abstraction forms, medical records/site reviews, member and physician satisfaction studies
- Analyze data and reports
- Research reporting issues and discrepancies; assist with remediation of report errors
- Conduct Interdepartmental calibrations of health plan requirements and quality
- Manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
- Implement process improvements to streamline departmental functions
- Responsible for intake and compilation of member surveys
- Assists in preparation for audits by regulatory agencies and review organizations
- Performs other duties as assigned
- Complies with all policies and standards
Associate’s degree in related field or equivalent experience.
4 years of data management experience, with a health insurance organization, in a position with accountability for report generation management or project management.
Working knowledge of MS Office applications.
Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.
Pay Range $55,100.00 - $99,000.00 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.
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
Salary : $55,100 - $99,000
