Job ID 1096862
Position Purpose: Develop and oversee quality improvement programs and strategies for the business unit. Assist in the development and application of the business unit’s strategic mission and vision. Identify and champion the selection of process improvement activities across the enterprise.
Responsible for driving performance improvement for HEDIS, Stars, State Contract Quality & Pay for Performance/Withhold, Marketplace QRS and Medicare Quality metrics and processes and other quality improvement opportunities as needed.
- Develop infrastructure and processes for management of activities related to National Committee for Quality Assurance (NCQA) Accreditation and Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation
- Oversee the development and implementation of enterprise wide and market specific process improvement programs
- Review and present results of quality interventions for clinical and operational performance improvements and identify organizational risks to executive management
- Develop and ensure consistent, reliable and valid application of data collection and analysis for priority performance measures, including HEDIS, pay for performance and contractual performance measures
- Review and analyze cost benefit and return on investment analyses for organizational resource allocation and recommend action plans
- Responsible for building relationship and positioning MHS as the “go to” source for state of the art MCE Quality Metrics.
Education/Experience: Bachelor's degree in healthcare or related clinical field. Master's in Business Administration preferred. 10+ years of healthcare operations experience including, quality and process improvement experience. Experience with NCQA accreditation preparation and auditing, including the analysis of HEDIS performance measures.
License/Certificates: Certified Professional in Health Care Quality (CPHQ). RN License 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.