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.
REMOTE OPPORTUNITY!
Centene is seeking a Quality Improvement Abstractor to support quality initiatives through accurate data abstraction, review, and validation of clinical data. The ideal candidate will have experience with HEDIS, quality measure abstraction, and overreads, ensuring accuracy, compliance, and consistency with established guidelines.
Requirements:
Experience with HEDIS, quality measure abstraction, and overreads
Familiarity with healthcare quality improvement processes, metrics, and documentation standards
RN or LPN license preferred (not required)
Strong attention to detail and ability to interpret clinical records accurately
Ability to work Monday–Friday, 8:00 AM–5:00 PM EST
Must reside in the Eastern (EST) or Central (CST) Time Zone
This role is ideal for detail-oriented professionals with a strong understanding of quality measures and experience ensuring data accuracy through abstraction and overread processes.
Position Purpose:
Lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA and/or any other custom measurements.
Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards.
Review medical records and abstract data for HEDIS and other measure sets in compliance with standards.
Track and report on issues and outcomes related to abstractions and over-reads
Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
Perform other quality initiatives as necessary
Performs other duties as assigned
Complies with all policies and standards
Education/Experience:
Associate’s degree in related field or equivalent experience. Bachelor degree preferred. 4+ years of nursing, medical assistant, medical coding or data management experience. Experience in quality initiatives (including HEDIS project, study analysis, or NCQA standards) preferred.
Licenses/Certifications: Current state’s RN or LPN license preferred.
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