Supervisor, Quality Member Engagement

Centene Corporation

22h • Hybrid

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. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Qualified candidates must reside in one of the following states and counties: Arizona (AZ): Maricopa, Yuma, Pima, or Cochise County California (CA): San Diego, San Bernardino, Los Angeles, Kern, Tulare, or Fresno County. Bilingual in Spanish or Chinese preferred. Texas (TX): Lubbock, Dallas, Bexar, Hidalgo, Starr, Cameron, or Hardin County. Bilingual in Spanish preferred. Additional Eligible States (statewide): Arkansas (AR), Illinois (IL), Georgia (GA), Pennsylvania (PA), Kentucky (KY), New York (NY), Mississippi (MS) This is a hybrid role that requires approximately 25% travel within 60 -mile radius from their home. Position Purpose: Oversee the day-to-day quality review function, ensuring accurate and timely review of department processes to ensure compliance with applicable state, federal and accrediting body requirements. Supervise and monitor the performance of Quality Care Member Advocates who support focusing on improving health outcomes by identifying and closing care gaps. Provide supervision for quality of care/service, including telephonic and in-person outreach to complex members, provider outreach, community events to support HEDIS care gap closure, and other applicable department activities including policies, procedures, workflows, letters, and reports. Provide in the field support to direct staff when deemed necessary. Communicate and reinforce standards for the quality team Prepare any applicable department state, federal, or accrediting body reports and submit timely. Prepare other quality review reports on departmental findings, identifying individual and organizational trends Identify and analyze team performance trends, address barriers, conduct coaching and performance management as deemed necessary, and recommend process improvements. Ensure non-clinical and clinical audits are conducted according to established tools and standards Provide recommendations for development, or revision of policies, procedures, work flows, documents or other documents to be used for training content or skill acquisition Research and respond to complex quality of care or quality of service inquiries. Coordinate with management to ensure the department output is meeting goals, expectations and requirements in alignment with the quality improvement department and program description and work plans. Performs other duties as assigned. Complies with all policies and standards.

Requirements

• Bachelor's Degree In related field, or equivalent experience required
• 5+ years Clinical or care coordination experience in health care.
• Managed care experience preferred required
• 1+ years Supervisory or team‑lead experience preferred, or demonstrated capability to lead and influence others preferred
• Demonstrated knowledge of the industry, including relevant terminology, practices, and standards
• Knowledge of industry and terminology required
• 1+ years Related experience required in care management, member outreach, or similar roles involving direct member engagement and coordination of services required
• LPN, RN, LCSW, LMSW, LMFT, LMHC, or LPC preferred
• Community-based experience such as social work, case management, or navigating community resources
• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
• Qualified candidates must reside in one of the following states and counties: Arizona (AZ): Maricopa, Yuma, Pima, or Cochise County California (CA): San Diego, San Bernardino, Los Angeles, Kern, Tulare, or Fresno County. Texas (TX): Lubbock, Dallas, Bexar, Hidalgo, Starr, Cameron, or Hardin County. Additional Eligible States (statewide): Arkansas (AR), Illinois (IL), Georgia (GA), Pennsylvania (PA), Kentucky (KY), New York (NY), Mississippi (MS)

Nice To Haves

• Bilingual in Spanish or Chinese preferred.
• Bilingual in Spanish preferred.

Responsibilities

• Oversee the day-to-day quality review function, ensuring accurate and timely review of department processes to ensure compliance with applicable state, federal and accrediting body requirements.
• Supervise and monitor the performance of Quality Care Member Advocates who support focusing on improving health outcomes by identifying and closing care gaps.
• Provide supervision for quality of care/service, including telephonic and in-person outreach to complex members, provider outreach, community events to support HEDIS care gap closure, and other applicable department activities including policies, procedures, workflows, letters, and reports.
• Provide in the field support to direct staff when deemed necessary.
• Communicate and reinforce standards for the quality team
• Prepare any applicable department state, federal, or accrediting body reports and submit timely.
• Prepare other quality review reports on departmental findings, identifying individual and organizational trends
• Identify and analyze team performance trends, address barriers, conduct coaching and performance management as deemed necessary, and recommend process improvements.
• Ensure non-clinical and clinical audits are conducted according to established tools and standards
• Provide recommendations for development, or revision of policies, procedures, work flows, documents or other documents to be used for training content or skill acquisition
• Research and respond to complex quality of care or quality of service inquiries.
• Coordinate with management to ensure the department output is meeting goals, expectations and requirements in alignment with the quality improvement department and program description and work plans.
• Performs other duties as assigned.
• Complies with all policies and standards.

Benefits

• Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager