Director, Quality Improvement – Digital Quality Measurement

🔥 1 hour ago

🏰 Missouri – Remote

🏰 Missouri – 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 to create more efficient and streamlined workflows • Shape and execute the organization's digital quality measurement strategy • Lead and collaborate 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, including HEDIS, CAHPS, and HOS • 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 • 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 internal and external guidelines • Lead the strategy, roadmap, testing, validation, and audit readiness for digital quality measurement, HEDIS, and related clinical quality initiatives

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor's Degree Nursing, other related field or equivalent experience required • 7+ years of quality management, quality improvement or healthcare operations experience required • Experience with digital quality measurement, HEDIS, ECDS, FHIR, healthcare interoperability, or related quality transformation initiatives highly preferred • Knowledge of audit readiness • Ability to translate clinical requirements into operational and technology solutions • Master's Degree preferred • 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

🏖️ 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 • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity