Quality Program Strategist II

Centene Corporation

7d•Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this position have the flexibility to work remotely from their home. Manager prefers candidates to have a deep understanding of CAHPS and HOS and be located in the Eastern or Central time zone. Occasional travel up to 10% may be required. Position Purpose: Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities. Assists 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. The assessment includes an end-to-end evaluation of the measure technical specification, performance trends, stakeholders, industry/research literature, organizational initiatives, associated policy and procedures, resources/tools. 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

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