Offer summary

Qualifications:

Associate’s degree in Nursing required; Bachelor’s degree in Nursing preferred., 3+ years of experience in nursing or related healthcare experience., RN/LCSW license required; CPHQ preferred., Strong clinical knowledge and ability to apply clinical criteria..

Key responsabilities:

Review medical records for potential Quality of Care incidents and determine compliance with standards of care.

Provide summaries of findings and severity levels to physicians.

Compile timelines and summaries of incidents for presentation to the medical director.

Ensure adherence to organizational policies and clinical protocols.

Job description

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.

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

Education/Experience: Associate’s degree in Nursing required; Bachelor’s degree in Nursing preferred. 3+ years of experience in nursing or related healthcare experience.

License/Certification: RN/LCSW required; CPHQ preferred

Pay Range: $33.03 - $59.47 per hour

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. 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

Required profile