Quality Program Development Manager

Centene Corporation•Remote-KY, NE

3d•$70,100 - $126,200•Remote

About The Position

Centene is seeking a Quality Program Development Manager to join their team. This role is crucial in transforming the health of their 28 million members by developing and implementing efficient and effective standards, policies, procedures, workflows, and decision support systems to improve clinical and administrative operations. The position supports regulatory and quality improvement initiatives, including coordination of NCQA, PIP, and state compliance deliverables across Medicaid and Medicare lines of business. Responsibilities include leading cross-functional efforts to manage complex deliverables, maintain audit readiness, and drive data-informed performance improvement. This role offers a meaningful impact on quality outcomes, regulatory performance, and member experience, with significant cross-functional leadership exposure and growth opportunities in a specialized area.

Requirements

A Bachelor's Degree in a related field, or equivalent work experience in Business, HC Management, or Nursing.
5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment.
3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH.
2+ years of experience in design, develop and implement STARS, CAHPS, HEDIS and other enterprise quality related programs across a variety of settings including: Defining the eligible population, service mix, delivery system configuration and financing.
Integration of behavioral, clinical, social, and community healthcare for members with multiple chronic conditions.
Working with multiple market leaders to coordinate consistent quality initiatives.
Conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Nice To Haves

A Master's Degree in a related field: Business or HC Management (MBA, MHA, MPH, MSN).
A license in one of the following is preferred: Six Sigma Certification, Lean Certification, Certified Professional in Healthcare Quality (CPHQ).
Expertise in regulatory compliance and accreditation (NCQA, PIPs, Medicaid/Medicare).
Experience leading cross-functional initiatives in fast-paced, deadline-driven environments.
Ability to analyze healthcare performance data and drive targeted quality improvements.
Strong skills in audit-ready documentation, reporting, and process improvement.
Background in managed care, quality, or program development (3–5+ years).

Responsibilities

Own regulatory and accreditation deliverables (NCQA, PIPs, state requirements), ensuring on-time submission and sustained audit readiness.
Drive audit readiness by establishing and maintaining scalable documentation, workflows, and submission processes that support compliance and reduce risk.
Leverage performance data to identify gaps, lead root cause analysis, and drive targeted quality improvement initiatives that enhance outcomes.
Oversee the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration.
Design and facilitate the development of various programs/systems, work flows, and integration efforts in alignment with Corporate, market, contractual, regulatory and quality requirements.
Act as the content and technical subject matter expert to the operation managers and directors for key project initiatives including the development of detailed work plans, facilitating route cause analysis, identifying and socializing process enhancements, setting deadlines, assigning responsibilities, and monitoring/summarizing project progress.
Prepare strategic analysis of potential business and/or operational opportunities in relation to new business, rebids, and QI targets using customized solutions.
Conduct needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner.
Partner with leaders and members of the Quality Analytics and Improvement Teams and determine data needs as well as assist in designing tools and reports as necessary.
Partner with clinical and operations staff with consulting and analysis services to support initiatives intended to achieve breakthrough or incremental process improvement in patient quality of care.
Conducts other responsibilities as needed.
Performs other duties as assigned.
Complies with all policies and standards.