Quality Improvement Coordinator II

Centene Corporation

Quality Improvement Coordinator auditing delegated healthcare entities, medical records, and quality programs. Supporting Centene’s mission to help 28 million members live healthier lives.

Posted 8/20/2026full-timeRemote • Wisconsin • 🇺🇸 United StatesMid-LevelSenior💰 $34 - $61 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality improvement processes, compliance audits, and clinical initiatives within healthcare settings. Proficient in data analysis, corrective action planning, and effective communication with healthcare providers and agencies.

Highest-signal resume keywords

Quality ImprovementClinical ExperienceHealthcare ComplianceData AnalysisCorrective Action Planning

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality AuditsMedical Record AuditsData CompilationUtilization ReviewCredentialing ReviewRisk ManagementComplaint ResolutionClinical InitiativesAbstractionsOverread

Soft Skills

CommunicationProblem-SolvingCollaborationLeadership

Certifications & Qualifications

CPHQLPNLVNRNPALCSW

Industry Keywords

HealthcareQuality Improvement CommitteeClinical StandardsService PerformanceUtilization Management

About the role

Key responsibilities & impact

Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits
Perform community activities related to clinical initiatives such as health fairs
Communicate with agencies and providers
Perform quality on-site reviews of delegated entities and physician offices/clinics
Resolve quality issues and generate written summaries of findings
Follow up as directed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC)
Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care issues
Audit medical records, review administrative claims and analyze data and interventions for quality improvement studies and activities
Function as the primary liaison between community resources/agencies and the company related to clinical initiatives and technical guidance
Schedule and chair meetings with delegated entities in accordance with their contract
Gather data and compile utilization and quality improvement reports
Develop and implement Corrective Action Plans
Recommend changes and enhancements to Quality Improvement policies and procedures
Identify best practices, research new processes and recommend program enhancements
Coordinate QIC activities and monthly meetings
Oversee enforcement of contract terms regarding data submission for delegated entities
Participate in development of reporting and data outcome reports
Perform other duties as assigned

Requirements

What you’ll need

Bachelor’s degree in Nursing preferred
3+ years of clinical, quality improvement or healthcare experience
2+ years of experience in quality function in a healthcare setting
LPN, LVN, RN, PA, or LCSW license preferred
CPHQ (Certified Professional in Healthcare Quality) preferred
Abstractions and Overread experience highly preferred
MedSurge experience highly preferred
Complies with all policies and standards

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation