Vice President, Quality Improvement

Job not on LinkedIn

October 28

🌾 Iowa – Remote

Although this job is listed in Iowa, this company may be open to hiring remote in other states.

🌪️ Kansas – Remote

Although this job is listed in Kansas, this company may be open to hiring remote in other states.

+2 more states

🌾 Iowa – Remote 🌪️ Kansas – Remote 🌾 Nebraska – Remote 🏰 Missouri – Remote

💵 $213.3k - $403.7k / year

⏰ Full Time

🔴 Lead

👔 Vice President

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Centene Corporation

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 Description

• Oversee all related activities for the Quality Improvement functions • Lead and direct process improvement activities for more efficient and streamlined workflow • Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans • Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation and health plan rating • Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review • Responsible for insuring no loss of revenue due quality performance related to state contracts either through Pay for Quality program or liquidated damages due not hitting dashboard measures • Responsible for managing member engagement vendor including the setting of performance standards and monitoring of performance standards • Review and implement new technological tools and processes and foster team concept with internal and external constituencies • Present results of improvement efforts and ongoing performance measures and recommend actions plans to senior management • Manage and ensure compliance of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program as well as compliance and turnaround time of quality of care reviews • Responsible for all activities related to risk adjustment performance ensuring highest level of return • Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines • Responsible for all activities related to Risk Adjustment performance including outreach and chart review to ensure highest level of return • Participate in, attend and plan/coordinate staff, departmental, committee, sub-committee, community, State and other activities, meetings and seminars • Work collaboratively with Provider Performance to support the expansion of alternative payment models using HEDIS data • Performs other duties as assigned • Complies with all policies and standards

🎯 Requirements

• Master's Degree in Nursing or related clinical field or equivalent experience required • 10+ years of experience managing acquisition and integration of external data sources required • Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff • Familiarity with running risk adjustment prospective and retrospective programs preferred • RN license and Certified Professional in Health Care Quality preferred • Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position

🏖️ Benefits

• 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