Director, Quality Improvement

🕒 Outubro 30

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $107.700 - $199.300 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Centene Corporation

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1984

🛡️ Seguros

💼 Consultoria

🏥 Saúde

Insurance • Consulting • Healthcare

Centene Corporation é uma provedora líder de serviços de saúde patrocinados pelo governo, especializada em oferecer soluções de saúde acessíveis e de alta qualidade. Há mais de 40 anos, a Centene tem se dedicado a transformar a saúde das comunidades, ampliando o acesso a Medicaid, Medicare e ao Health Insurance Marketplace, além de atender comunidades militares por meio do programa TRICARE. Como a maior organização de managed care do Medicaid e participante-chave no Marketplace, a Centene enfatiza a entrega de cuidados de saúde com foco local, combinada a parcerias sólidas com organizações sem fins lucrativos para atender às necessidades únicas de seus membros. A Centene também é comprometida com sustentabilidade corporativa e responsabilidade social, priorizando a gestão ambiental e a governança ética para promover o bem-estar das comunidades que atende.

Descrição

• Lead and direct process improvement activities that provide more efficient and streamlined workflow • Lead and collaborate with others on NCQA Accreditation and/or HEDIS performance • Lead quality improvement aspects of risk adjustment processes for all products • Collaborate with the Medicare STARS team to improve STARS ratings for Medicare products • Oversee provider satisfaction surveys and implement improvement action plans • Research and incorporate best practices into operations • Organize and control activities, methods, and procedures to achieve business objectives • Review and implement new technological tools and processes and foster team concepts with internal and external constituencies • Present improvement results and ongoing performance measures to senior management • Formulate and establish policies, operating procedures, and goals in compliance with guidelines • Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities, and reduce cost of care • Monitor application of standards with agencies, community stakeholders, and communities • Promote cultural competence throughout the health plan through culturally inclusive best practices and provider training • Oversee assessment of provider-network cultural diversity, identify resources and gaps, and develop credentialing and network-development recommendations • Monitor and evaluate provider practices through KPIs and health equity dashboards • Oversee population-specific activities, cultural treatment teams, and community support systems • Oversee the outcomes-based Cultural Competency Plan aligned with CLAS standards and national and regional priorities • Incorporate data-driven assessments and strategies for continual monitoring and improvement of culturally competent performance • Manage outreach budget for Cultural Competency programs and sponsorships • Perform other duties as assigned • Comply with all policies and standards

🎯 Requisitos

• Must reside in Indiana or be willing to relocate to Indiana • Bachelor's Degree Nursing, other related field or equivalent experience required • 7+ years of quality management, quality improvement or healthcare operations experience required • Certain states may require a formal certification in quality improvement, risk management, or another parallel field • Current state’s RN license preferred • Certified Professional in Health Care Quality preferred • Master's Degree preferred • Ability to lead and collaborate on NCQA Accreditation and/or HEDIS performance • Knowledge of Medicare STARS, including HEDIS, CAHPS, and HOS • Knowledge of cultural competency, CLAS standards, health equity, and provider network assessment

🏖️ Benefícios

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity

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