Centene Corp

Quality Improvement Specialist Senior

Centene Corp • $70K — $126K *
US-AnywhereRemote in Pennsylvania, US
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor’s Degree or equivalent with clinical license or Master’s Degree in a related health field
  • Minimum three years experience in a clinical/health care environment
  • Three to five years managed care experience
  • Experience in compliance, accreditation, service or quality improvement
  • Complex project management experience
  • Valid state clinical license preferred, CPHQ certification preferred

Responsibilities

  • Lead and manage multiple complex health care initiatives
  • Ensure compliance with accreditation, state and federal quality standards
  • Conduct assessments to refine programs for better outcomes
  • Manage vendor relationships and oversee program activities
  • Develop activities to improve Star Ratings and performance measures
  • Create communication materials related to quality improvement projects
  • Develop reports to track initiative progress and present to senior staff

Benefits

  • Health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible work arrangements including remote and hybrid options
Full Job Description

Can reside in any state. Will work EST hours

Experience: Managed Care, HEDIS, CAHPS, NCQA, Medicare/Medicaid/CHIP/Marketplace

Position Purpose: The Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical quality and/or service improvement programs. Functions as a leader for assigned health services initiatives handling multiple large-scale complex initiatives. Collaborates on national, regional and multi-plan initiatives. Develops programs in compliance with accreditation and regulatory requirements/ standards and monitors ongoing program performance to maintain compliance. Acts as a resource for training, policy and regulatory/accreditation interpretation.

  • Leads and manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services provided to members.

  • Ensures that clinical and service quality improvement programs and initiatives are compliant with applicable accreditation, state and federal requirements.

  • Conducts an assessment of programs, initiatives and interventions to ensure goals and objectives were met and refine activities, as needed, to improve the effectiveness and improve outcomes.

  • Conducts vendor oversight and management.

  • Develops targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other identified performance measures.

  • Develops and implements project-related communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas.

  • Participates in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities.

  • Develops internal reports to demonstrate progress on each initiative/project and presents to senior-level staff.

  • Describes outreach initiatives, potential/experienced barriers and activities to resolve issues and improve outcomes.

  • Leads and/or participates in multi-department/cross-functional committees and work groups which support key initiatives, prepares reports, data, agendas/minutes or other materials for committee presentation and management.

  • Identifies areas of improvement within the company and works collaboratively with other departments to develop clinical and non-clinical performance improvement projects.

  • Researches best practices, national and regional benchmarks, and industry standards.

  • Develops collaborative relationships with contracted providers or provider groups to promote participation in quality improvement collaboratives to improve clinical care outcomes.

  • May lead and/or participate in external activities, work groups or committees when applicable.

  • Communicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures.

  • Develops and/or maintains relationships with other external organizations to expand key partnerships.

  • Assesses current industry trends and regulations for enterprise-wide adoption to assure quality and effectiveness of health care delivery and/or healthcare services provided to members.

  • Performs all other duties as assigned.
  • Performs other duties as assigned

  • Complies with all policies and standards

Education/Experience:
Education: Bachelor’s Degree or equivalent experience with clinical license or Master’s Degree in related health field (i.e. MPH or MPA)

Certification/License: Valid state clinical license preferred
Certified Professional in Health Care Quality (CPHQ) preferred.

Experience: Minimum three years experience in a clinical/health care environment with related degree program
Three to five years managed care experience in a health care environment
Experience in compliance, accreditation, service or quality improvement
Complex project management experience

Experience with Medicare and/or NCQA preferred:

Pay Range: $70,100.00 - $126,200.00 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.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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