Director, Quality & Process Improvement, HEDIS Audit

🕒 Junho 2

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Centene Corporation

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1984

⚕️ Seguro de Saúde

🤝 Sem Fins Lucrativos

🌍 Impacto Social

Healthcare Insurance • Non-profit • Social Impact

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 initiatives by utilizing process improvement methodologies in the analysis of current operations and design of improvement projects across all areas that impact operations • Support NCQA HEDIS audit readiness and compliance, ensuring accurate and timely submissions • Lead daily audit readiness activities, including Roadmaps, Section 5 documentation, Measure Specifications, CAHPS coordination, and auditor engagement • Oversee the administration, coordination and evaluation of quality assurance and training • Direct the execution of performance improvement projects, including process mapping and process design including HEDIS audit timelines and deliverables • Serve as primary point of contact for auditors and leadership, supporting audit communications and successful outcomes • Create and maintain dashboards, communications, and strategies to improve effectiveness • Research and develop best practices, policies, procedures, and goals in compliance with internal and external guidelines • Oversee data analysis and gathering processes and programs to establish costs and benefits of process effectiveness and efficiency • Ensure business unit is compliant with URAC and Joint Commission Accreditation standards • Review and implement new technological tools and processes • Establish strong collaborative relationships with all functional units and their leaders

🎯 Requisitos

• Bachelors Degree in related field • 6+ years of quality and process improvement experience • Healthcare industry experience preferred • Knowledge of research methodologies including measures and outcomes • knowledge of process mapping, process design, and workflow management software and applications • URAC and Joint Commission Accreditation experience preferred • Experience with NCQA HEDIS measures or audit processes highly preferred

🏖️ Benefícios

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules