Senior Quality Improvement Specialist

🕒 August 20

🐊 Florida, Iowa, +4 more states – Remote

🐊 Florida – Remote 🌾 Iowa – Remote 🌪️ Oklahoma – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🤠 Texas – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 32%

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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

• Coordinate assigned regulatory, accreditation, clinical quality and/or service improvement programs • Lead multiple large-scale complex health services initiatives • Collaborate on national, regional and multi-plan initiatives • Develop programs compliant with accreditation and regulatory requirements and monitor performance • Lead initiatives impacting the quality or effectiveness of health care delivery and services • Assess programs, initiatives and interventions and refine activities to improve outcomes • Conduct vendor oversight and management • Develop targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other performance measures • Develop project communications including member/physician mailings, IVR scripts, emails, business plans and graphics • Maintain quality improvement program documents, evaluations, compliance audits, policies and procedures • Develop internal reports and present progress to senior-level staff • Describe outreach initiatives, barriers and resolution activities • Lead or participate in cross-functional committees and work groups • Identify improvement opportunities and develop clinical and non-clinical performance improvement projects • Research best practices, benchmarks and industry standards • Develop relationships with contracted providers and provider groups • Communicate programs, interventions and results to external entities • Develop and maintain relationships with external organizations • Assess industry trends and regulations for enterprise-wide adoption • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• HEDIS Operations experience highly preferred • Clinical Medical Record Review experience • Bachelor’s Degree or equivalent experience with clinical license, or Master’s Degree in a related health field (i.e. MPH or MPA) • Minimum three years experience in a clinical/health care environment with related degree program • Three to five years managed care experience in a health care environment • Experience in compliance, accreditation, service or quality improvement • Complex project management experience • Experience with Medicare and/or NCQA preferred • Valid state clinical license preferred • Certified Professional in Health Care 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 • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity