Accreditation Specialist

Centene Corp.; Northern (KY); Hybrid; USD 56,000 - 101,000; Full time

Job summary

Centene Corp. is seeking a clinical quality professional to develop Performance Improvement projects and coordinate NCQA/HEDIS activities to support accreditation and quality metrics.

This role allows remote work within the continental United States, with preferred EST schedule; compensation ranges from $56,200 to $101,000 per year plus benefits.

Qualifications

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

Responsibilities

• Develop Performance Improvement projects to improve clinical quality and performance measures.
• Coordinate NCQA/HEDIS work plans and accreditation readiness activities.
• Create policies to support accreditation activities and audits.
• Provide training for Plan, provider network, and delegated vendors on NCQA/HEDIS.

Skills

Quality improvement

HEDIS

NCQA

Education

Bachelor's degree in Business or related field

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.

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

Pay Range: $56,200.00 - $101,000.00 per year 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. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Diversity & Equal Opportunity

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.