Accreditation Specialist

Centene Management Company LLC; Georgia; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote, hybrid, field or office work S

Job summary

Centene Management Company LLC is seeking a Quality Improvement professional to develop and oversee HEDIS and NCQA initiatives, drive accreditation readiness, and coordinate with delegated vendors and the Plan.

The role requires a Bachelor’s degree in Business or related field and 3+ years of quality improvement experience. The position offers remote work within the continental US and a schedule aligned to EST, with competitive pay and a comprehensive benefits package.

Qualifications

• Bachelor’s degree in Business, related field or equivalent experience.
• 3+ years of related quality improvement, HEDIS and/or NCQA experience.

Responsibilities

• Develop Performance Improvement projects to improve clinical quality and performance measure outcomes.
• Coordinate delegation oversight mechanisms and liaise for the Plan with Corporate Delegation Oversight.
• Develop accreditation readiness schedule and support NCQA/HEDIS activities.
• Create policies and procedures for accreditation activities and conduct training.
• Coordinate NCQA and HEDIS work plan activities and assist with delegation oversight audits.

Skills

Quality improvement

HEDIS

NCQA

Education

Bachelor's degree in Business or related field

Job description

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Applicants for this role have the flexibility to work remotely within the continental United States. To support the needs of the business, preferred schedule is based on Eastern Standard Time zone.

Position Purpose:

Develop Performance Improvement projects to improve clinical quality and performance measure outcomes. Develop and coordinate delegation oversight mechanisms and act as liaison for the Plan with Corporate Delegation Oversight. Develop and maintain accreditation readiness schedule. Creates policy and procedures to support accreditation activities. Conduct training and education programs for Plan, provider network, delegated vendors to support NCQA and HEDIS activities. Develop QI, NCQA and HEDIS projects with delegated vendors to support accreditation maintenance and HEDIS reporting. Coordinate assigned NCQA and HEDIS work plan activities. Assist with delegation oversight audits and coordinate corrective action plans to ensure compliance with all state, federal, contract and accreditation requirements.

Education/Experience:

Bachelor’s degree in Business, related field or equivalent experience. 3+ years of related quality improvement, HEDIS and/or NCQA experience.

Pay Range:

$56,200.00 - $101,000.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.