Health Coordinator

• Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations
• Lead clinical quality initiatives
• Review clinical information for appeals to determine medical necessity of services
• Prepare reviews and cases for appeals and fair hearings
• Develop and implement the behavioral health quality program description, work plan goals, HEDIS measures and program evaluation documents
• Lead Behavioral Health Performance Improvement Projects (PIPs)
• Maintain files, logs and documentation, including communications, in accordance with NCQA and State standards and regulations
• Investigate and resolve behavioral health quality of care complaints and grievances
• Act as liaison for appeals and fair hearings
• Perform other duties as assigned

Explore Quality Improvement Coordinator – Behavioral Health at Centene Corporation. Review requirements and application details.