Quality Program Strategist II

Centene • Springfield, IL

407d • $67,400 - $121,300

About The Position

The Quality Program Strategist II at Centene Corporation is responsible for identifying market trends and overseeing quality improvement programs related to HEDIS, CAHPS, and HOS strategies. This role involves analyzing stakeholder business issues, conducting evaluations for performance improvement, and collaborating with cross-functional teams to ensure successful execution of strategic initiatives. The strategist will leverage data analysis to provide actionable insights and develop resources to enhance member and provider experiences.

Requirements

• Bachelor's degree in Nursing, Public Health, related field, or equivalent experience; Master's degree preferred.
• 4+ years of clinical experience, managed care or health insurance experience required; 2+ years of quality experience preferred.
• Intermediate proficiency with analytical tools (e.g., Excel).
• Ability to create and maintain key presentations.
• Proficient use of Quality Improvement tools (e.g., Root Cause Analysis).
• Experience with CMS MA and DSNP technical specifications.
• Solid understanding of CMS MA Star and DSNP ratings and strategies to improve performance.

Nice To Haves

• Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW) preferred.
• CPHQ preferred.

Responsibilities

• Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy.
• Assist stakeholders in determining business issues and recommend solutions to drive business value.
• Analyze stakeholder business issues, formulate hypotheses, and test conclusions to determine appropriate solutions.
• Conduct evaluations to assist with HEDIS gap closure, CAHPS and/or HOS performance.
• Assess potential pilot programs and/or process improvements to achieve sustainable quality performance goals.
• Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements.
• Collaborate and provide support to markets & key business stakeholders to drive continued measure performance.
• Develop HEDIS, CAHPS, and/or HOS support resources and tools to foster gap closure & improve experience for members and providers.
• Conduct ongoing assessments to determine health plan needs, collaborating with cross-functional teams.
• Monitor and ensure compliance related to state reporting, HHS and HPMS memos for quality ratings.
• Establish quality check policy/procedures for all member and provider communications.
• Create, maintain and facilitate training for Quality Improvement Health Plan staff.

Benefits

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

What This Job Offers

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