Manager, Quality Practice Advisor

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $87.7k - $157.8k / 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

• Provide leadership and direction for clinical, quality, and risk adjustment functions • Develop and oversee clinical programs for physician education and communication • Develop the team in activities that increase member quality of care, reduce costs, and identify risk adjustment opportunities • Provide and analyze reports to identify trends, opportunities, and recommended actions • Coordinate with other departments to prioritize provider engagement and communication opportunities for clinical, quality, and risk adjustment projects • Establish and maintain tracking and monitoring systems for health care quality improvement activities according to regulatory requirements, risk adjustment policies and procedures, and contractual agreements • Ensure high-risk, high-volume, and unusual events are monitored concurrently and retrospectively • Manage and evaluate staff performance related to clinical and health care services performance improvement activities • Provide guidance, training, and development to department associates • Coordinate guidelines, studies, and performance improvement activities with quality management, pharmacy services, and risk management programs • Coordinate external programmatic oversight visits for contracted providers and ensure timely completion and follow-up on corrective action plans

🎯 Requirements

• A bachelor’s degree in Health Care, Nursing, Public Health Administration or Business, or equivalent work experience is required • 3 or more years of supervisory/management experience • 5+ years’ experience working in a managed care environment • Registered Nurse, Certified Health Care Risk Management certification, Foreign MD, or American Academy of Professional Coders certification preferred • Knowledge of HEDIS requirements • Experience with clinical performance methods to improve HEDIS performance • Ability to coordinate external programmatic oversight visits and corrective action plans

🏖️ 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