Quality Improvement Specialist – HEDIS II

Centene Corporation

. Take a lead role in developing and maintaining quality improvement projects specific to HEDIS Hybrid Operations .

Posted 9/24/2026full-timeRemote • Missouri • United StatesJuniorMid-Level💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in HEDIS Hybrid Operations, quality improvement methodologies, and clinical medical record abstraction. Capable of leading quality performance improvement initiatives and training stakeholders in best practices.

Highest-signal resume keywords

HEDIS Measures OwnershipQuality Improvement MethodologiesClinical Medical Record AbstractionPerformance Indicator MonitoringTeam Training and Mentorship

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality Improvement ProjectsHEDIS AbstractionData EntryInter-Rater ReliabilityPDSA Model ImplementationGap IdentificationPerformance TrackingAudit ProcessesMeasure InterpretationQuality Performance Improvement Plans

Soft Skills

LeadershipCommunicationMentoringCollaborationAnalytical Thinking

Certifications & Qualifications

Bachelor’s Degree in NursingBachelor’s Degree in HealthcareBachelor’s Degree in Quality

Industry Keywords

HEDISNCQAQuality MeasuresHealthcareContinuous Quality Improvement

About the role

Key responsibilities & impact

Take a lead role in developing and maintaining quality improvement projects specific to HEDIS Hybrid Operations
Serve as primary owner for assigned HEDIS measures
Train providers, health plans, and staff in continuous quality improvement methodologies and tools, HEDIS abstraction, and over-read processes
Provide clinical support to medical record abstraction, over-read, and audit processes
Monitor performance on established contractual quality indicators
Analyze, track, and trend results
Prepare for and participate in meetings with committees, state agencies, providers, health plans, vendors, and stakeholders
Recommend, develop, and implement quality performance improvement plans (PIPs) with management using the PDSA model
Monitor and report PIP progress through closure
Conduct year-round pseudo-claims performance, gap identification, and intervention and strategy planning for assigned HEDIS measures
Support department leadership in project and strategy development
Lead complex or high-risk HEDIS quality improvement initiatives with market-wide impact
Provide guidance on complex abstraction scenarios, team training, measure interpretation, abstraction standards, and quality improvement best practices
Mentor and serve as a resource to team members
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Bachelor’s degree in Nursing, Healthcare, or Quality (including HEDIS measures or NCQA) or equivalent experience in related healthcare experience
Requires 2+ years of experience in Quality
Knowledge of HEDIS & performance measures strongly preferred
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Advanced proficiency across all phases of clinical medical record abstraction, including data entry, over read, and inter-rater reliability (IRR/third level over read)
Functional and technical knowledge regarding overall program requirements and operations
Critical clinical abstraction knowledge for guidance on complex abstraction scenarios, team training, and measure interpretation

Benefits

Comp & perks

competitive pay
health insurance
401K
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