Director, Quality Program Strategy
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. Applicants must reside in the state of Pennsylvania. The position will primarily be remote with the exception of 2-4 days in the field or in office a month. Previous experience working in a managed care setting is highly preferred. Position Purpose: Lead and direct the development, implementation and management oversight of Centene’s quality programs and improvement initiatives. Oversee aspects of the company quality measure improvement outreach strategy including the execution of function for all markets and products Direct quality measures portfolio management for all products through development and execution of best practices towards achieving market and product quality and risk goals Serve as subject matter expert in measure development and methodology Define business requirements and strategies for data capture to close risk and care gaps Perform root cause analysis, failure mode, and effective analysis and identify opportunities to mitigate future risks Plan and direct programs, and initiatives related to HEDIS Stars and quality ratings systems, Medicaid pay for performance, accreditation targets and HOS improvement and gap closure Communicate risk, organizational impact and progress towards achieving goals to executive leadership Identify Market and Product strengths, weaknesses, opportunities and threats Develop work process for supplemental data capture in compliance with HEDIS technical specifications
Requirements
- Bachelor's degree in Nursing, related clinical degree or equivalent experience.
- 7+ years of healthcare related experience including quality improvement, HEDIS operations, and Risk Adjustment.
- Experience with quality rating systems, Medicare products, Medicare Stars, and Marketplace products.
Nice To Haves
- Current state’s RN license preferred.
- Previous experience working in a managed care setting is highly preferred.
Responsibilities
- Lead and direct the development, implementation and management oversight of Centene’s quality programs and improvement initiatives
- Oversee aspects of the company quality measure improvement outreach strategy including the execution of function for all markets and products
- Direct quality measures portfolio management for all products through development and execution of best practices towards achieving market and product quality and risk goals
- Serve as subject matter expert in measure development and methodology
- Define business requirements and strategies for data capture to close risk and care gaps
- Perform root cause analysis, failure mode, and effective analysis and identify opportunities to mitigate future risks
- Plan and direct programs, and initiatives related to HEDIS Stars and quality ratings systems, Medicaid pay for performance, accreditation targets and HOS improvement and gap closure
- Communicate risk, organizational impact and progress towards achieving goals to executive leadership
- Identify Market and Product strengths, weaknesses, opportunities and threats
- Develop work process for supplemental data capture in compliance with HEDIS technical specifications
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Director
