Quality Program Strategist II

Centene Corporation•Remote-FL, FL

11d•$70,100 - $126,200

About The Position

The Quality Program Strategist II identifies market trends and oversees quality improvement program functions for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities. The role helps stakeholders define business issues, analyzes those issues, develops and tests hypotheses, and recommends solutions that drive business value. The position requires residence in Florida, experience with multiple lines of business, and experience with Five Why’s and/or Fishbone analysis. The strategist evaluates opportunities for HEDIS gap closure and CAHPS and/or HOS performance improvements, including potential pilot programs and process improvements that support sustainable quality goals. Evaluations may include measure technical specifications, performance trends, stakeholders, industry and research literature, organizational initiatives, policies and procedures, and available resources and tools. The role uses data analysis to develop actionable insights and strategic recommendations, collaborates with markets and business stakeholders, and develops resources and tools to support gap closure and improve member and provider experience. The position assesses health plan needs and works with cross-functional teams to execute strategic initiatives. It monitors compliance related to state reporting and HHS and HPMS memos for quality ratings. It also establishes quality-check policies and procedures for member and provider communications and recurring departmental programs and activities; creates, maintains, and facilitates training for Quality Improvement Health Plan staff as applicable; and performs other assigned duties while complying with policies and standards. Centene describes its work as supporting access to healthcare and healthier lives. The company offers competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible remote, hybrid, field, or office work arrangements. Actual pay depends on relevant factors, and total compensation may include incentives. Benefits may be subject to eligibility.

Requirements

Must reside in Florida.
Experience with multiple lines of business.
Experience with Five Why’s and/or Fishbone analysis.
Bachelor’s degree in Nursing, Public Health, a related field, or equivalent experience.
At least 4 years of clinical experience, managed care experience, or health insurance experience.
Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse, or Licensed Clinical Social Worker (LCSW) credential preferred.
CPHQ certification preferred.

Nice To Haves

Master’s degree preferred.
At least 2 years of quality experience preferred.
Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse, or Licensed Clinical Social Worker (LCSW) credential preferred.
CPHQ certification preferred.

Responsibilities

Identify market trends and oversee quality improvement program functions for HEDIS, CAHPS, and/or HOS strategy and related activities.
Help stakeholders identify business issues; analyze them, formulate and test hypotheses, and recommend solutions that drive business value.
Evaluate opportunities for HEDIS gap closure and CAHPS and/or HOS performance improvement, including potential pilot programs and process improvements.
Assess measure technical specifications, performance trends, stakeholders, industry and research literature, organizational initiatives, policies and procedures, and available resources and tools.
Use data analysis to develop actionable insights and strategic recommendations for performance improvement.
Collaborate with and support markets and key business stakeholders to improve measure performance.
Develop HEDIS, CAHPS, and/or HOS support resources and tools to foster gap closure and improve member and provider experience.
Assess health plan needs and collaborate with cross-functional teams to execute strategic initiatives end to end.
Monitor compliance related to state reporting and HHS and HPMS memos for quality ratings.
Establish quality-check policies and procedures for member and provider communications to ensure accuracy and alignment with business goals.
Establish QPS policies, procedures, and quality checks for recurring departmental programs and activities.
Create, maintain, and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibilities.
Perform other duties as assigned and comply with all policies and standards.