Quality Program Strategist II

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🔥 0 minutes ago

🦌 Connecticut, Florida, +2 more states – Remote

🦌 Connecticut – Remote 🐊 Florida – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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 and related activities • Assist stakeholders in identifying business issues and recommend solutions that drive business value • Analyze stakeholder business issues, formulate hypotheses, test conclusions, and determine appropriate 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 and research literature, organizational initiatives, policies, procedures, resources, and tools • Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements • Collaborate with and support markets and key business stakeholders to drive measure performance • Develop HEDIS, CAHPS, and/or HOS support resources and tools to foster gap closure and improve member and provider experience • Assess health plan needs and collaborate with cross-functional teams to execute strategic initiatives end to end • Monitor and ensure compliance with state reporting and 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 • Comply with all policies and standards

🎯 Requirements

• Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience • Master’s degree preferred • 4+ years of clinical experience, managed care, or health insurance experience required • 2+ years of quality experience preferred • Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse, or Licensed Clinical Social Worker (LCSW) preferred • CPHQ preferred • Experience with member engagement and improving member experience and CAHPS scores strongly preferred • Ability to align schedule with EST hours • Ability to analyze business issues, formulate hypotheses, and test conclusions • Data analysis skills • Knowledge of HEDIS, CAHPS, and/or HOS quality improvement programs • Ability to monitor compliance with state reporting, HHS, and HPMS requirements • Ability to develop policies, procedures, quality checks, resources, and training

🏖️ 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 • Accommodation support during the candidate journey