Director, Quality Improvement

🔥 20 hours ago

🇺🇸 United States – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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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