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.
To be considered for this Quality Program Development Manager role, candidates will bring a bachelor's degree (or equivalent experience) and 5+ years of healthcare program or project management experience, including 3+ years in managed care. Candidates should also have at least 2+ years of experience designing and implementing quality programs (e.g., HEDIS, CAHPS, STARS) and working across cross-functional healthcare environments.
Position Purpose: Functions as a program development manager in collaboration with Quality, Health Services and Operations business owners or cross-functional work groups in the development and implementation of efficient and effective standards, policy and procedures, work flows, and decision support systems to support ongoing improvements of clinical and administrative operations.
This role will support regulatory and quality improvement initiatives, including coordination of NCQA, PIP, and state compliance deliverables across Medicaid and Medicare lines of business. Responsibilities include leading cross-functional efforts to manage complex deliverables, maintain audit readiness, and drive data-informed performance improvement. Experience in healthcare regulatory, accreditation, or quality improvement environments preferred.
In this Quality Program Development Manager role, you will:- Own regulatory and accreditation deliverables (NCQA, PIPs, state requirements), ensuring on-time submission and sustained audit readiness
- Drive audit readiness by establishing and maintaining scalable documentation, workflows, and submission processes that support compliance and reduce risk
- Leverage performance data to identify gaps, lead root cause analysis, and drive targeted quality improvement initiatives that enhance outcomes
- Oversees the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration.
- Designs and facilitates the development of various programs/systems, work flows, and integration efforts in alignment with Corporate, market, contractual, regulatory and quality requirements.
- Acts as the content and technical subject matter expert to the operation managers and directors for key project initiatives including the development of detailed work plans, facilitating route cause analysis, identifying and socializing process enhancements, setting deadlines, assigning responsibilities, and monitoring/summarizing project progress.
- Prepares strategic analysis of potential business and/or operational opportunities in relation to new business, rebids, and QI targets using customized solutions.
- Conducts needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner.
- Partners with leaders and members of the Quality Analytics and Improvement Teams and determines data needs as well as assists in designing tools and reports as necessary
- Partners with clinical and operations staff with consulting and analysis services to support initiatives intended to achieve breakthrough or incremental process improvement in patient quality of care
- Conducts other responsibilities as needed.
- Performs other duties as assigned
- Complies with all policies and standards
What's appealing about this role:- Meaningful, visible impact - Directly influences quality outcomes, regulatory performance, and member experience through high-impact initiatives (NCQA, PIPs, and compliance deliverables)
- Cross-functional leadership exposure - Partner with leaders across Quality, Clinical, Operations, and Analytics to drive enterprise initiatives and strategic decisions
- Growth in a specialized, in-demand area - Build expertise in regulatory compliance, accreditation, and data-driven performance improvement while leading complex, high-priority work
Education/Experience:Required: A Bachelor's Degree in a related field, or equivalent work experience in Business, HC Management, or Nursing
Preferred: A Master's Degree in a related field: Business or HC Management (MBA, MHA, MPH, MSN)
Required experience:- 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment
- 3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH
- 2+ years of experience in design, develop and implement STARS, CAHPS, HEDIS and other enterprise quality related programs across a variety of settings including:
- Defining the eligible population, service mix, delivery system configuration and financing
- Integration of behavioral, clinical, social, and community health care for members with multiple chronic conditions
- Working with multiple market leaders to coordinate consistent quality initiatives
- Conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide
Licenses and Certifications: A license in one of the following is preferred:
- Preferred Six Sigma Certification
- Preferred Lean Certification: Preferred Certified Professional in Healthcare Quality (CPHQ)
Highly preferred:- Expertise in regulatory compliance and accreditation (NCQA, PIPs, Medicaid/Medicare)
- Experience leading cross-functional initiatives in fast-paced, deadline-driven environments
- Ability to analyze healthcare performance data and drive targeted quality improvements
- Strong skills in audit-ready documentation, reporting, and process improvement
- Background in managed care, quality, or program development (3-5+ years)
Applicants for this role have the flexibility to work
remotely from home anywhere within the continental United States. Due to business needs, availability to support
Central or Eastern Time working hours is preferred.NOTE: 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.
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.
