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Quality Improvement Coordinator – Behavioral Health
| Company | Centene |
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| Location | Louisiana, USA |
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| Salary | $33.03 – $59.47 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Mid Level |
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Requirements
- Must reside in Louisiana
- Licensed mental health professional (LCSW, LPC, LMFT, LAC, etc.)
- At least 2 years of clinical experience
- Knowledge in Microsoft tools (Word, Excel, Teams, etc.) is a must
- PowerBI experience highly preferred
Responsibilities
- Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives
- Review clinical information for appeals to determine medical necessity of services
- Prepare reviews for cases
- Act as the liaison for appeals and fair hearings
- Develop and implement the quality program description, work plan goals including applicable Healthcare Effectiveness Data and Information Set (HEDIS) measures and program evaluation (trilogy documents) for behavioral health
- Lead Behavioral Health Performance Improvement Projects (PIPS)
- Maintain files, logs, documentation including communication in accordance with National Committee for Quality Assurance (NCQA) and State standards and regulations including timelines
- Investigate and resolve behavioral health quality of care complaints and grievances
- Perform other duties as assigned
- Comply with all policies and standards
Preferred Qualifications
- Quality/auditing experience is preferred
- Experience in Behavioral Healthcare field preferred
- Registered Nurse (RN) certification
- Licensed Mental Health Professional (LMHC)
- Licensed Professional Counselor (LPC)
