Senior Quality Improvement Specialist

🕒 August 11

🇺🇸 United States – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 24%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 • Act as a resource for training and policy/regulatory/accreditation interpretation • Lead initiatives impacting quality or effectiveness of healthcare delivery and services • Ensure quality improvement programs comply with accreditation, state and federal requirements • Assess programs, initiatives and interventions; 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 member/physician mailings, IVR scripts, emails, business plans and graphics • Maintain quality improvement program documents, evaluations, compliance audits, policies, procedures and improvement activities • Develop internal reports and present initiative progress to senior-level staff • Describe outreach initiatives, barriers and resolution activities • Lead or participate in cross-functional committees and work groups; prepare reports, data, agendas, minutes and presentation materials • Identify improvement areas and collaborate on clinical and non-clinical performance improvement projects • Research best practices, benchmarks and industry standards • Build relationships with contracted providers and provider groups to promote quality improvement collaboratives • Participate in external activities, work groups or committees • 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 assigned duties and comply with company 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 • Experience in Managed Care, HEDIS, CAHPS, NCQA, Medicare/Medicaid/CHIP/Marketplace • Ability to work EST hours • Ability to reside in any state

🏖️ 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