Director, Quality Improvement

Centene Corporation•Remote-MO, MO

1d•$118,400 - $219,000•Remote

About The Position

Centene is transforming the health of its communities, one person at a time. This is a remote opportunity supporting enterprise-wide quality strategy initiatives throughout the year. Experience with HEDIS operations and quality strategy initiatives is highly preferred. The position leads and directs process improvement activities for more efficient and streamlined workflows. It is responsible for leading and collaborating on NCQA Accreditation and/or HEDIS performance, quality improvement aspects of risk adjustment processes, and collaborating with the Medicare STARS team to improve overall STARS ratings. The role also oversees provider satisfaction surveys, implements action plans for improvements, researches and incorporates best practices, organizes and controls activities, methods, and procedures to achieve business objectives, reviews and implements new technological tools and processes, and fosters team concepts. Additionally, it presents results of improvement efforts and ongoing performance measures to senior management and formulates and establishes policies, operating procedures, and goals in compliance with internal and external guidelines. For the Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only, this role oversees Coordinated Care's Cultural Competency Program, leads Coordinated Care’s Health Disparities efforts, collaborates with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities and reduce the cost of care, monitors the application of all standards, promotes an environment of cultural competence, oversees the assessment of cultural diversity of the provider network, monitors and evaluates provider practices through KPIs within health equity dashboards, oversees population-specific activities, and manages the outreach budget for Cultural Competency programs and sponsorships. Performs other duties as assigned and 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.

Nice To Haves

Master's Degree preferred.
Certified Professional in Health Care Quality preferred.
Experience with HEDIS operations and quality strategy initiatives is highly preferred.

Responsibilities

Lead and direct process improvement activities that provide more efficient and streamlined workflow.
Lead and collaborate 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.
Oversee Coordinated Care's Cultural Competency Program, including its Cultural Competency Plan focused on Culturally and Linguistically Appropriate Services (CLAS) (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Lead Coordinated Care’s Health Disparities efforts, including those focused on justice involved individual members (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities and reduce the cost of care (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Work closely with State, County and local agencies, community stakeholders and communities to monitor the application of all standards (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Promote an environment of cultural competence throughout the health plan through identification and implementation of culturally-inclusive best practices and innovations, such as the development of provider trainings to improve cultural awareness and competency within the provider network (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Oversee the assessment of cultural diversity of the provider network to identify resources and gaps, including needs analysis for non-traditional providers (traditional healers, religious and spiritual resources, natural support systems, etc.) and develops recommendations for credentialing and network development activities (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Monitor and evaluate provider practices through KPIs within health equity dashboards to assess and improve the cultural competence of delivered services by addressing care gaps and aligning interventions to resolve (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Oversee the population specific activities (such as training, awareness through the media, and partnering with various external equity stakeholders), including cultural treatment teams and other cultural community support system activities (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Oversee the comprehensive, outcomes-based Cultural Competency Plan that is aligned with CLAS standards and national and regional priorities/initiatives. The plan also incorporates data-driven assessments of culturally competent performance, and defines a strategy for the continual provision, monitoring and improvement of culturally competent performance (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Manage outreach budget for Cultural Competency programs and sponsorships (For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only).
Performs other duties as assigned.
Complies with all policies and standards.