Quality Reporting Specialist

Position Purpose: Organize and assemble various quality indicators which are reported to the Quality Management Risk Management Committee. Coordinate Quality of Care (QOC) tracking process and the operational department reporting to ensure timely submission to the payors.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

This is a remote role with an expectation to work onsite at our Tempe, AZ office approximately once per month.

• Prepare Quality Improvement (QI) reports and submit for review prior to submission.
• Track incident, accident, and death (IAD) reports and correspond to QOC investigations to ensure resolution meets the timeliness standards and ensure appropriate information is provided the payor.
• Organize and assemble IAD and QOC data for the QM Committee, the Credentialing Committee, and other entities.
• Ensure that all departments submit reports timely to the Payors.
• Participate in the Risk Committee or other appropriate committees as designated.
• Conduct audits of the State IAD-QOC database to ensure data integrity and timeliness of portal submissions.
• Prepare provider financial sanctions for review prior to submission.
• Serve as primary point of contact to resolve provider issues regarding IADs and QOCs.

Education/Experience: High school diploma or equivalent. 2+ years of experience in a health care setting that includes coordination of member care through physicians, clinical nurses and office managers. In depth knowledge of medical/mental health terminology required.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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