Vice President, Quality Management

Centene

4d

About The Position

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Position Purpose: The Vice President of Quality Management has national responsibility for all aspects of the quality management program for the Health Plan Division (HPD) and maintaining NCQA accreditation status for each regional area. Responsible for leading the organization in the development of effective and efficient business processes. Candidate must reside in NC. Preferably in the Charlotte area. Leads the development and implementation of the HPD's Quality Program and ensures national consistency of best practices for all members and providers. Acts as advisor and consultant to business unit leadership on processed and outcomes related to the accreditation program. Leads monitoring and audit preparation activities to ensure the health plan and contracted network processes are in compliance with regulatory and accreditation agencies. Leads and oversees the Delegated Oversight Department and ensures delegated provider and clinical vendor performance are in compliance. Leads and participates in national and regional committees that promote and oversee quality, accreditation programs and initiatives to monitor the quality of care, delivery and access. Ensures compliance with company standards related to clinical measurement programs transparency, data exchange, ethics and public reporting. Develops and implements provider education/intervention programs for aberrant or outlier care practices including development of clinical evidence-based clinical guidelines. Participates in the implementation of medical program strategic development and deployment in collaboration with the Medical Integration team. Programs include, but are not limited to, Wellness, Preference Sensitive Conditions, Disease State Management, Chronic Conditions and Special Populations. Works collaboratively with various HPD departments to manage health care outcomes and trends including implementing mechanisms to leverage national and local network management agreements. Leads the process to monitor the effectiveness of all quality-related programs. Oversees the design, implementation and monitoring of enterprise-wide customer satisfaction measurement and initiatives to improve the customer's perception of services. Collaborates with national HEDIS team in the data collection process at the provider level and leads national/regional data analysis and member/provider strategy and interventions. Directs the preparation of short-term and long-range plans and budgets. Leads management of the quality team and drives staff development opportunities.

Requirements

• Bachelor's Degree in a clinical science or related health care field required.
• 5+ years managed care experience with knowledge of accreditation standards and regulatory requirements required.
• 5+ years clinical experience required.
• 5+ years quality management experience required.
• Demonstrated leadership experience in health plan operations and local delivery system.
• Experience with and in-depth understanding of accrediting organizations and federal and state regulations and requirements.
• Current, valid and unrestricted licensed clinician (e.g. LCSW, RN, MD, DO, PhD/PsyD, etc.) required.

Nice To Haves

• Master's Degree preferred.

Responsibilities

• Has national responsibility for all aspects of the quality management program for the Health Plan Division (HPD) and maintaining NCQA accreditation status for each regional area.
• Responsible for leading the organization in the development of effective and efficient business processes.
• Leads the development and implementation of the HPD's Quality Program and ensures national consistency of best practices for all members and providers.
• Acts as advisor and consultant to business unit leadership on processed and outcomes related to the accreditation program.
• Leads monitoring and audit preparation activities to ensure the health plan and contracted network processes are in compliance with regulatory and accreditation agencies.
• Leads and oversees the Delegated Oversight Department and ensures delegated provider and clinical vendor performance are in compliance.
• Leads and participates in national and regional committees that promote and oversee quality, accreditation programs and initiatives to monitor the quality of care, delivery and access.
• Ensures compliance with company standards related to clinical measurement programs transparency, data exchange, ethics and public reporting.
• Develops and implements provider education/intervention programs for aberrant or outlier care practices including development of clinical evidence-based clinical guidelines.
• Participates in the implementation of medical program strategic development and deployment in collaboration with the Medical Integration team.
• Works collaboratively with various HPD departments to manage health care outcomes and trends including implementing mechanisms to leverage national and local network management agreements.
• Leads the process to monitor the effectiveness of all quality-related programs.
• Oversees the design, implementation and monitoring of enterprise-wide customer satisfaction measurement and initiatives to improve the customer's perception of services.
• Collaborates with national HEDIS team in the data collection process at the provider level and leads national/regional data analysis and member/provider strategy and interventions.
• Directs the preparation of short-term and long-range plans and budgets.
• Leads management of the quality team and drives staff development opportunities.

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: Executive
• Number of Employees: 5,001-10,000 employees