Manager, Performance Quality Improvement

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🔥 17 minutes ago

🌾 Iowa, Kansas – Remote

🌾 Iowa – Remote 🌪️ Kansas – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

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.

📋 Description

• Provide strategic oversight of HEDIS Operations and Quality Improvement initiatives • Drive excellence in NCQA and HEDIS performance across the organization • Lead hybrid season planning and execution • Ensure audit readiness and regulatory reporting compliance • Oversee vendor management and chart retrieval operations • Implement data-driven strategies to improve quality measure performance and health outcomes • Analyze data to develop intervention strategies to improve outcomes • Develop and implement performance improvement projects • Develop, prepare, and present reports on quality programs and issues to both internal and external stakeholders • Provide data analysis and support for QM projects (i.e. outcome studies, QI projects) • Coordinate ongoing data management for HEDIS and QI project management databases • Evaluate sources for alternative data capture, assess ongoing methodology and results • Oversee the medical record management process for HEDIS reporting • Develops tracking, tools, and programs to support HEDIS staff to drive HEDIS and 5 Star project improvement activities

🎯 Requirements

• Bachelor's degree in healthcare, business, or related field or equivalent experience • 4+ years of quality improvement data and outcome analysis experience in health care • Experience in managed care with knowledge of HEDIS and NCQA preferred • Experience leading HEDIS Operations within a health plan, managed care, or healthcare quality environment • Strong knowledge of NCQA accreditation standards, HEDIS measures, hybrid methodology, and audit requirements • Demonstrated success managing hybrid reviews, chart retrieval operations, and vendor relationships • Experience with regulatory reporting, quality improvement programs, and performance measurement initiatives • Proven ability to lead large-scale operational projects and collaborate effectively across clinical, quality, analytics, and operations teams

🏖️ 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