Position Purpose:Lead and direct process improvement activities that provide more efficient and streamlined workflow. This leadership role will shape and execute the organization's digital quality measurement strategy, helping modernize how clinical quality data is collected, validated, and reported.
Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
Applicants for this job have the flexibility to work remote from home anywhere in the United States.
Experience with digital quality measurement, HEDIS, ECDS, FHIR, healthcare interoperability, or related quality transformation initiatives highly preferred. The ideal candidate will combine strategic thinking with knowledge of audit readiness and the ability to translate clinical requirements into operational and technology solutions.
- Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
- Responsible for quality improvement aspects of risk adjustment processes for all products
- Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS)
- Oversee provider satisfaction surveys and implement action plans for improvements
- Research and incorporate best practices into operations
- Organize and control activities, methods, and procedures to achieve business objectives
- Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
- Present results of improvement efforts and ongoing performance measures to senior management
- Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
- Lead the strategy, roadmap, testing, validation, and audit readiness for digital quality measurement, HEDIS, and related clinical quality initiatives
Education/Experience: Bachelor's Degree Nursing, other related field or equivalent experience required. Master's Degree preferred. 7+ years of quality management, quality improvement or healthcare operations experience required
Licenses/Certifications: Certain states may require a formal certification in quality improvement, risk management, or another parallel field
Current state's RN license preferred
Certified Professional in Health Care Quality preferred
Pay Range: $107,700.00 - $199,300.00 per year
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.
