Manager, Performance Quality Improvement

Centene • West Des Moines, IA

261d • $86,000 - $154,700

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 for this role have the flexibility to work remotely from their home. Position Purpose: Oversee and manage the functions of the quality improvement program from inception to closure, including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Sets (HEDIS) performance improvement projects. Oversee quality improvement related activities and staff to improve clinical quality performance measures. Analyze data to develop intervention strategies to improve outcomes. Develop and implement performance improvement projects. Develop, prepare, and present reports on quality programs and issues to both internal and external stakeholders. Provide data analysis and support for QM projects (i.e. outcome studies, QI projects). Coordinate ongoing data management for HEDIS and QI project management databases. Evaluate sources for alternative data capture, assess ongoing methodology and results. Develop, implement and monitor data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements. Oversees the medical record management process for HEDIS reporting, including all processes involved with year round abstraction and MRR. Responsible for creation and maintenance of training materials used by Quality Improvement Specialist and Patient Care Advocates during the HEDIS and 5 Star projects. Oversee Patient Care Advocate and HEDIS team including workflow, tracking, reporting and improvement of processes related to member engagement and MRR efforts. Develops tracking, tools, and programs to support PCA and HEDIS staff to drive HEDIS and 5 Star project improvement activities. Ensures MRR efforts meet NCQA HEDIS audit standards. Performs other duties as assigned. Complies with all policies and standards.

Requirements

• Bachelor's degree in healthcare, business, or related field or equivalent experience.
• 4+ years of quality improvement data and outcome analysis experience in health care.
• Experience in managed care with knowledge of HEDIS and NCQA preferred.

Nice To Haves

• Certified Professional in Healthcare Quality (CPHQ) preferred.

Responsibilities

• Oversee and manage the functions of the quality improvement program from inception to closure.
• Oversee quality improvement related activities and staff to improve clinical quality performance measures.
• Analyze data to develop intervention strategies to improve outcomes.
• Develop and implement performance improvement projects.
• Develop, prepare, and present reports on quality programs and issues to both internal and external stakeholders.
• Provide data analysis and support for QM projects (i.e. outcome studies, QI projects).
• Coordinate ongoing data management for HEDIS and QI project management databases.
• Evaluate sources for alternative data capture, assess ongoing methodology and results.
• Develop, implement and monitor data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
• Oversee the medical record management process for HEDIS reporting.
• Responsible for creation and maintenance of training materials used by Quality Improvement Specialist and Patient Care Advocates during the HEDIS and 5 Star projects.
• Oversee Patient Care Advocate and HEDIS team including workflow, tracking, reporting and improvement of processes related to member engagement and MRR efforts.
• Develop tracking, tools, and programs to support PCA and HEDIS staff to drive HEDIS and 5 Star project improvement activities.
• Ensure MRR efforts meet NCQA HEDIS audit standards.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree