Senior Quality Improvement Specialist

🔥 0 minutes ago

🐊 Florida, Iowa, +2 more states – Remote

🐊 Florida – Remote 🌾 Iowa – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟠 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

• Coordinate assigned regulatory, accreditation, clinical quality and/or service improvement programs • Lead assigned health services initiatives involving multiple large-scale complex initiatives • Collaborate on national, regional and multi-plan initiatives • Develop programs compliant with accreditation and regulatory requirements and monitor performance • Serve as a resource for training and policy/regulatory/accreditation interpretation • Lead and manage initiatives affecting quality or effectiveness of healthcare 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 annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities • Develop internal progress reports and present to senior-level staff • Describe outreach initiatives, barriers and resolution activities • Lead or participate in cross-functional committees and work groups and prepare presentation materials • Identify improvement areas and collaborate across departments on clinical and non-clinical performance improvement projects • Research best practices, benchmarks and industry standards • Develop relationships with providers and provider groups to promote quality improvement collaboratives • Participate in external activities, work groups or committees when applicable • Communicate programs, interventions and results to external entities • Maintain relationships with external organizations and expand partnerships • Assess industry trends and regulations for enterprise-wide adoption • Perform other assigned duties and comply with policies and standards

🎯 Requirements

• Bachelor’s Degree or equivalent experience with clinical license, or Master’s Degree in related health field (e.g. MPH or MPA) • Valid state clinical license preferred • Certified Professional in Health Care Quality (CPHQ) preferred • 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 • HEDIS Operations experience highly preferred • Clinical Medical Record Review experience

🏖️ 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 • Equal opportunity employer committed to diversity