Quality Program Strategist II

🔥 0 minutes ago

🐊 Florida, Kentucky, +2 more states – Remote

🐊 Florida – Remote 🐎 Kentucky – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 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

• Identify market trends and oversee quality improvement programs for HEDIS, CAHPS, and/or HOS strategy • Assist stakeholders in determining business issues and recommend solutions to drive business value • Analyze stakeholder business issues, formulate hypotheses, and test conclusions to determine solutions • Conduct evaluations for HEDIS gap closure, CAHPS and/or HOS performance, pilot programs, and process improvements • Evaluate measure technical specifications, performance trends, stakeholders, industry/research literature, organizational initiatives, policies, procedures, and resources/tools • Leverage data analysis to derive actionable insights and strategic recommendations • Collaborate with markets and key business stakeholders to improve measure performance • Develop HEDIS, CAHPS, and/or HOS support resources and tools for gap closure and member/provider experience • Assess health plan needs and collaborate cross-functionally on strategic initiatives • Monitor compliance with state reporting, HHS and HPMS memos for quality ratings • Establish quality check policies and procedures for member and provider communications • Establish QPS policies, procedures, and quality checks for recurring departmental programs and activities • Create, maintain, and facilitate training for Quality Improvement Health Plan staff • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience • 4+ years of clinical experience, managed care or health insurance experience required • Experience with member engagement, improving member experience and CAHPS and HOS strongly preferred • 2+ years of quality experience preferred • Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW), preferred • CPHQ preferred • Schedule aligned with Eastern Standard Time (EST) • Compliance with all policies and standards

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