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. This is a remote role with the ideal candidates living in EST or CST time zones. Position Purpose: Provide leadership and direction for continuous quality improvement (QI) initiatives to improve efficiency, processes and demonstrate improved quality. Provide and analyze reports to identify trends, opportunities and recommend initiatives aimed at improving quality of care and services provided by the organization. Oversee accreditation process, specifically as it pertains to National Committee for Quality Assurance (NCQA) Accreditation and compliance with contractual requirements. Responsible for overall coordination of company-wide quality assessment and improvement activities. Oversee and coordinate with Corporate on annual file audits and other quality related initiatives to include those of a contractual nature. Manage and implement appropriate work tools/processes, reports and audit tools to ensure control of key processes and program characteristics. Recommend quality improvement opportunities based on findings and participation in developing and implementing solutions to management and the Quality Improvement Committee (QIC) and other committees, as appropriate. Provide feedback to rectify errors and to prevent further inconsistencies. Oversee monthly and quarterly reports and data to identify trends, opportunities for improvement and interventions. Responsible for policies, operating procedures, and aligning goals in compliance with internal and external guidelines.
Responsibilities
- Provide leadership and direction for continuous quality improvement (QI) initiatives.
- Analyze reports to identify trends and recommend initiatives for improving quality of care.
- Oversee accreditation process for NCQA Accreditation and compliance with contractual requirements.
- Coordinate company-wide quality assessment and improvement activities.
- Manage annual file audits and other quality-related initiatives.
- Implement work tools/processes, reports, and audit tools for key processes.
- Recommend quality improvement opportunities and participate in developing solutions.
- Provide feedback to rectify errors and prevent inconsistencies.
- Oversee monthly and quarterly reports to identify trends and opportunities for improvement.
- Ensure policies and operating procedures align with internal and external guidelines.
Requirements
- Bachelor's degree in Business, Healthcare, or related field.
- Master's degree preferred.
- 5+ years of quality management experience or equivalent leadership experience.
- Previous experience managing cross-functional teams on large scale projects.
- Supervisory experience including hiring, training, and managing performance of staff.
- HEDIS experience highly preferred.
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 work)
