Quality Program Strategist II

Centene Corporation

1d•Hybrid

About The Position

Centene is transforming the health of its communities, one person at a time, serving 28 million members. This role involves identifying market trends and overseeing quality improvement programs for HEDIS, CAHPS, and/or HOS strategy. The position assists stakeholders in identifying business issues and recommending solutions to drive business value. Responsibilities include analyzing business issues, formulating hypotheses, and conducting evaluations for HEDIS gap closure, CAHPS and/or HOS performance, and assessing potential pilot programs or process improvements to achieve sustainable quality performance goals. This assessment encompasses an end-to-end evaluation of measure technical specifications, performance trends, stakeholders, industry literature, organizational initiatives, policies, and resources. The role leverages data analysis for actionable insights and strategic recommendations, collaborates with markets and business stakeholders to enhance measure performance, and develops support resources and tools for gap closure and improved member/provider experience. Ongoing assessment of health plan needs and collaboration with cross-functional teams are key to ensuring successful execution of strategic initiatives. The position also monitors compliance with state reporting, HHS, and HPMS memos for quality ratings, establishes quality check policies/procedures for member and provider communications, and creates/maintains training for Quality Improvement Health Plan staff. The role performs other duties as assigned and complies with all policies and standards.

Requirements

Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience.
4+ years of clinical experience, managed care or health insurance experience required.
2+ years of quality experience preferred.
Data Analysis experience highly preferred.
PowerBI and Fishbone experience highly preferred.

Nice To Haves

Master’s degree preferred.
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 and related quality improvement activities.
Assist stakeholders to determine their 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 and assess for 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 assessment to determine health plan needs, collaborating with cross-functional teams to ensure successful end to end execution of strategic initiatives.
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 to ensure accuracy of information, data, and alignment with Centene business goals.
Establish QPS policies, procedures, and quality checks for all reoccurring departmental programs/activities, to ensure precision execution and accuracy.
Create, maintain and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibility.
Performs other duties as assigned.
Complies with all policies and standards.