Director, Quality Improvement

Centene Corporation

2d•Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This is a remote opportunity with a preference or working EST/CST Director will have oversight of Medical Record Retrieval- experience this area is highly preferred Position Purpose: Lead and direct process improvement activities that provide more efficient and streamlined workflow. 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 Performs other duties as assigned Complies with all policies and standards

Requirements

Bachelor's Degree Nursing, other related field or equivalent experience required
7+ years of quality management, quality improvement or healthcare operations experience required
Medical Record Retrieval experience is highly preferred

Nice To Haves

Master's Degree preferred
Certified Professional in Health Care Quality preferred

Responsibilities

Lead and direct process improvement activities that provide more efficient and streamlined workflow.
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
Performs other duties as assigned
Complies with all policies and standards