Quality Program Development Manager

🔥 17 hours ago

🌽 Illinois, Missouri – Remote

🌽 Illinois – Remote 🏰 Missouri – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 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

• Collaborate with Quality, Health Services and Operations business owners or cross-functional work groups to develop and implement standards, policies, procedures, workflows, and decision support systems • Oversee creation and implementation of programs supporting strategic initiatives in Health Services, clinical quality, and operational quality administration • Design and facilitate programs, systems, workflows, and integration efforts aligned with corporate, market, contractual, regulatory, and quality requirements • Serve as content and technical subject matter expert to operations managers and directors • Develop detailed work plans, facilitate root cause analysis, identify and socialize process enhancements, set deadlines, assign responsibilities, and monitor and summarize project progress • Lead state-required Performance Improvement Projects (PIPs), including topic selection, root cause analysis, implementation, and final submission • Conduct needs assessments and ensure program teams and external stakeholders receive information timely • Partner with Quality Analytics and Improvement Teams to determine data needs and assist in designing tools and reports • Consult with clinical and operations staff and provide analysis services for patient quality-of-care improvement initiatives • Conduct other responsibilities and duties as assigned • Comply with all policies and standards

🎯 Requirements

• A Bachelor's Degree in a related field required • Equivalent work experience in Business, HC Management, or Nursing accepted • 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment • 3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH • 2+ years of experience designing, developing, and implementing STARS, CAHPS, HEDIS and other enterprise quality-related programs • Experience defining eligible populations, service mix, delivery system configuration and financing • Experience integrating behavioral, clinical, social, and community health care for members with multiple chronic conditions • Experience working with multiple market leaders to coordinate consistent quality initiatives • Experience conducting assessments, contractual reviews, and business plans for new quality improvement programs • Experience integrating innovative approaches to defined programs to improve quality ratings company wide • Six Sigma Certification, Lean Certification, or Certified Professional in Healthcare Quality (CPHQ) preferred

🏖️ Benefits

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