Director, Quality Improvement, Digital Quality Measurement

Centene Corporation; United States; Remote; 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

Remote, hybrid, field or office work

Job summary

Centene Corporation is seeking a high-impact leader in digital quality measurement and quality improvement. The role focuses on shaping the organization’s strategy for collecting, validating, and reporting clinical quality data, with emphasis on HEDIS, NCQA accreditation, and risk adjustment across products.

The position allows remote work from anywhere in the United States. The ideal candidate will combine strategic thinking with audit readiness and the ability to translate clinical

Qualifications

• Bachelor's Degree in Nursing or related field; Master's degree preferred.

Responsibilities

• Lead and collaborate on NCQA Accreditation and HEDIS performance.
• Own quality improvement aspects of risk adjustment for all products.
• Collaborate with Medicare STARS team to improve STARS ratings for Medicare products.
• 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 foster team collaboration.
• Present results of improvement efforts and ongoing performance measures to senior management.
• Formulate policies, operating procedures, and goals in compliance with guidelines.
• Lead strategy, roadmap, testing, validation, and audit readiness for digital quality measurement and related clinical quality initiatives.

Education

Bachelor's Degree in Nursing or related field

Job description

Position Purpose:

Lead and direct process improvement activities that provide more efficient and streamlined workflow. This leadership role will shape and execute the organization’s digital quality measurement strategy, helping modernize how clinical quality data is collected, validated, and reported.

Key Details:

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 job have the flexibility to work remote from home anywhere in the United States.

Experience with digital quality measurement, HEDIS, ECDS, FHIR, healthcare interoperability, or related quality transformation initiatives highly preferred. The ideal candidate will combine strategic thinking with knowledge of audit readiness and the ability to translate clinical requirements into operational and technology solutions.

• - 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
• - Lead the strategy, roadmap, testing, validation, and audit readiness for digital quality measurement, HEDIS, and related clinical quality initiatives

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
• 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