Quality Improvement Specialist

4 weeks ago


Anderson, South Carolina, United States Absolute Total Care Full time

Transform the health of our communities, one person at a time. As a Quality Improvement Specialist at Absolute Total Care, you'll lead data collection and abstraction for company quality measures, including HEDIS, CMS, CHIPRA, and other custom measurements.

Key Responsibilities:
  • 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
Requirements:
  • Associate's degree in a related field or equivalent experience
  • 4+ years of nursing, medical assistant, medical coding, or data management experience
  • Experience in quality initiatives (including HEDIS projects, study analysis, or NCQA standards) preferred
  • Advanced knowledge of Microsoft Applications, including Excel and Access

Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K, and stock purchase plans. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.



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