Quality Improvement Project Manager
About The Position
Centene is seeking a Quality Improvement Project Manager to coordinate and monitor quality improvement and organizational projects from inception to closure, including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) preparation. This role involves providing functional and technical knowledge for NCQA/HEDIS, coordinating work plans, analyzing data, designing data review processes, implementing interventions, adhering to NCQA standards, supporting corporate compliance, and maintaining project documentation. The position is crucial for ensuring the accuracy and integrity of data reports, meeting regulatory requirements, and supporting the overall quality improvement initiatives of the plan.
Requirements
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
- Qualified candidates must reside in the state of Florida.
- Bachelor’s degree in Healthcare, Business or equivalent experience.
- 4+ years of quality improvement or project management experience in managed care.
- Advanced knowledge of HEDIS and NCQA.
- Proficiency required in Microsoft applications including PowerPoint, Excel and Access.
Nice To Haves
- Registered Nurse (RN), Licensed Practical Nurse, Licensed Clinical Social Worker (LCSW) or CPHQ certification highly preferred.
- Master's in Public Health or related field preferred.
Responsibilities
- Coordinate and monitor quality improvement and organizational projects from inception to closure.
- Provide functional and technical knowledge for NCQA/HEDIS across all plan departmental staff.
- Deliver educational sessions to internal staff and external constituents as needed.
- Coordinate Work Plan, team and resources for HEDIS/Consumer Assessment of Healthcare Providers and Systems (CAHPS) submission to Connector Authority and NCQA.
- Analyze data and develop presentations and materials for committee and articles for newsletters and other educational pieces.
- Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
- Coordinate and implement interventions to increase HEDIS, CAHPS and designated health measures for the Plan.
- Adhere to NCQA standards and work with Corporate Director of Accreditation in maintaining Plan’s NCQA accreditation.
- Support the coordination of corporate compliance and external surveys as needed.
- Monitor the creation of all project deliverables to ensure adherence to standards including design documents, test plans and operations documentation.
- Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure.
- Coordinate all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects with department staff and corporate contacts.
- Evaluate sources for alternative data capture; assess ongoing methodology and results.
- Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans.
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off
- 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
Mid Level
