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Quality of Care Coordinator

Charlotte, North Carolina Apply Now Job ID 1158354 Category Medical Management Organization Carolina Complete Health Schedule Full-time
Description:

Position Purpose:

Review medical records for quality of care incidents by determining if the specified standards of care were met, and assigning an initial severity level of lack of compliance/care
Compile timeline and summary of incident, including the details of the potential QOC for presentation to the medical director for a final review; may also be involved in peer review committee actions or next steps
Maintains organizational and program policies and procedures; ensures adherence to prescribed policies and procedures and clinical protocols where appropriate

Qualifications:

Review medical records for potential Quality of Care (QOC) incidents, applying clinical criteria to determine if a lack of care was present. Utilize clinical knowledge to provide summary of findings and severity level to physicians.

Education/Experience:
Associate’s degree in Nursing required; Bachelor’s degree in Nursing preferred. 3+ years of experience in nursing or related healthcare experience.

License/Certification:
RN/LCSW required; CPHQ preferred

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.

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