Director, Quality Improvement

Centene Corp.; Indiana; Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corp. in Indiana seeks a senior professional to lead process improvement across risk adjustment, NCQA accreditation, and HEDIS performance. The role collaborates with Medicare STARS teams and local agencies to enhance outcomes and reduce disparities.

Candidates should have a nursing background, 7+ years in quality management, and relevant certifications; Master’s preferred. The position offers a flexible schedule with on-site or hybrid options and competitive pay.

Qualifications

• Bachelor's Degree Nursing or related field or equivalent experience.
• 7+ years of quality management, quality improvement or healthcare operations experience.
• Master's Degree preferred.
• RN license preferred; Certified Professional in Health Care Quality preferred.

Responsibilities

• Lead NCQA Accreditation and HEDIS performance initiatives.
• Oversee quality improvement aspects of risk adjustment processes.
• Collaborate with Medicare STARS team to improve ratings for Medicare products.
• Monitor and improve provider satisfaction; implement action plans.
• Present results to senior management; formulate policies and procedures.

Skills

Quality management

Quality improvement

Healthcare operations

Leadership

Education

Bachelor's Degree in Nursing

Master's Degree

Job description

Position Purpose: Lead and direct process improvement activities that provide more efficient and streamlined workflow. Key Details: Must reside in Indiana or be willing to relocate to Indiana.

• Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
• Responsible for quality improvement aspects of risk adjustment processes for all products
• Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS)
• Oversee provider satisfaction surveys and implement action plans for improvements
• Research and incorporate best practices into operations
• Organize and control activities, methods, and procedures to achieve business objectives
• Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
• Present results of improvement efforts and ongoing performance measures to senior management
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
• Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities and reduce the cost of care.
• Work closely with State, County and local agencies, community stakeholders and communities to monitor the application of all standards
• Promote an environment of cultural competence throughout the health plan through identification and implementation of culturally-inclusive best practices and innovations, such as the development of provider trainings to improve cultural awareness and competency within the provider network
• Oversee the assessment of cultural diversity of the provider network to identify resources and gaps, including needs analysis for non-traditional providers (traditional healers, religious and spiritual resources, natural support systems, etc.) and develops recommendations for credentialing and network development activities.
• Monitor and evaluate provider practices through KPIs within health equity dashboards to assess and improve the cultural competence of delivered services by addressing care gaps and aligning interventions to resolve.
• Oversee the population specific activities (such as training, awareness through the media, and partnering with various external equity stakeholders), including cultural treatment teams and other cultural community support system activities.
• Oversee the comprehensive, outcomes-based Cultural Competency Plan that is aligned with CLAS standards and national and regional priorities/initiatives.
• The plan also incorporates data-driven assessments of culturally competent performance, and defines a strategy for the continual provision, monitoring and improvement of culturally competent performance.
• Manage outreach budget for Cultural Competency programs and sponsorships.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Bachelor's Degree Nursing, other related field or equivalent experience required.

Master's Degree preferred.

7+ years of quality management, quality improvement or healthcare operations experience required.

Licenses/Certifications: Certain states may require a formal certification in quality improvement, risk management, or another parallel field. Current state’s RN license preferred. Certified Professional in Health Care Quality preferred.

Pay Range: $107,700.00 - $199,300.00 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. 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.

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