Senior Quality Improvement Specialist

🔥 16 hours ago

🌾 Iowa, Kansas – Remote

🌾 Iowa – Remote 🌪️ Kansas – 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 multiple large-scale complex health services initiatives and collaborate on national, regional and multi-plan initiatives • Lead Medicaid state withhold and pay-for-performance programs • Develop and monitor measure-level action plans, interventions, reporting, and financial impact • Ensure quality improvement programs comply with accreditation, state and federal requirements • Assess programs, initiatives and interventions and refine activities to improve effectiveness and 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 mailings, IVR scripts, emails, business plans, graphics, agendas and minutes • Maintain quality improvement program documents and evaluations, compliance audits, policies, procedures and improvement activities • Develop internal progress reports and present to senior-level staff • 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 • Build relationships with providers and provider groups to promote quality improvement collaboratives • Communicate programs, interventions and results to external entities • Maintain external partnerships and assess industry trends and regulations for enterprise-wide adoption • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor’s Degree or equivalent experience with clinical license, or Master’s Degree in related health field (i.e. 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 • Knowledge of accreditation, regulatory, state and federal requirements • Ability to interpret contractual requirements and performance targets • Experience developing and monitoring action plans, interventions, reporting, and financial impact

🏖️ Benefits

• competitive pay • health insurance • 401K • stock purchase plans • tuition reimbursement • paid time off plus holidays • a flexible approach to work with remote, hybrid, field or office work schedules • additional forms of incentives may be included in total compensation

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