Manager, Performance Quality Improvement
About The Position
Centene is seeking an experienced quality manager to provide strategic oversight of HEDIS Operations and Quality Improvement initiatives, driving excellence in NCQA and HEDIS performance across the organization. This role will lead hybrid season planning and execution, ensure audit readiness and regulatory reporting compliance, oversee vendor management and chart retrieval operations, and implement data-driven strategies to improve quality measure performance and health outcomes. The ideal candidate brings expertise in managed care quality programs, cross-functional leadership, and continuous process improvement to support organizational quality and regulatory goals.
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
- Experience leading HEDIS Operations within a health plan, managed care, or healthcare quality environment.
- Strong knowledge of NCQA accreditation standards, HEDIS measures, hybrid methodology, and audit requirements.
- Demonstrated success managing hybrid reviews, chart retrieval operations, and vendor relationships.
- Experience with regulatory reporting, quality improvement programs, and performance measurement initiatives.
- Proven ability to lead large-scale operational projects and collaborate effectively across clinical, quality, analytics, and operations teams.
- Certified Professional in Healthcare Quality (CPHQ) preferred.
Responsibilities
- 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.
- Oversee HEDIS team including workflow, tracking, reporting and improvement of processes related to member engagement and MRR efforts.
- Develops tracking, tools, and programs to support 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.
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off
- holidays
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What This Job Offers
Job Type
Full-time
Career Level
Manager
