Quality Program Strategist II

Centene Corporation•New York, NY

21h•$70,100 - $126,200•Remote

About The Position

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. This is a remote position. Schedule will align with Eastern Standard Time (EST). Experience with member engagement, improving member experience and CAHPS and HOS strongly preferred. 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.

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
Experience with member engagement, improving member experience and CAHPS and HOS strongly preferred.

Responsibilities

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