Director, Quality Improvement

Centene Management Company LLC; United States; Remote; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K plan

Tuition reimbursement

Stock purchase plans

Job summary

Centene is seeking a senior quality leader to direct process improvements across healthcare operations. You will lead NCQA/HEDIS accreditation efforts, drive risk-adjustment quality, and collaborate with the Medicare STARS team to improve overall ratings.

You will oversee provider satisfaction surveys, implement corrective actions, and promote culturally competent care through KPI dashboards, training programs, and community partnerships. This role requires Indiana residency or relocation.

Qualifications

• Bachelor's Degree in Nursing, other related field or equivalent experience required.
• Master's Degree preferred with 7+ years of quality management or healthcare operations experience.

Responsibilities

• Lead and direct process improvement initiatives across healthcare operations.
• Drive NCQA/HEDIS accreditation and risk-adjustment quality.
• Collaborate with Medicare STARS to improve ratings.
• Oversee provider satisfaction surveys and action plans.
• Promote cultural competence using data-driven KPIs and trainings.
• Develop policies and operating procedures to meet guidelines.
• Manage outreach budgets and partnerships to reduce health disparities.
• Present results to senior management and stakeholders.

Skills

Process improvement

Quality management

Healthcare operations

Stakeholder collaboration

Leadership

Education

Bachelor's Degree in Nursing or related field

Master's Degree preferred

Tools

Quality metrics dashboards

Data analysis software

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.

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.