Head of Risk & Quality Operations (Healthcare)

Centene Corporation; Elm (PA); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedule (remote/hybrid/

office/field work options)

Job summary

Centene Corporation is seeking a detail-oriented professional to lead risk adjustment and quality improvement initiatives across assigned products and plans in PA. You will design action plans, coordinate across departments, and develop workflows that align business requirements with local market dynamics.

The role emphasizes dashboard creation for senior leadership and ongoing improvement, with a focus on healthcare accessibility and effectiveness.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 4+ years of project management, operations, quality improvement or data analysis in healthcare.
• Clinical or Social work experience preferred.
• Previous managed care or Medicare experience preferred.
• Experience improving healthcare access and effectiveness is a plus.
• Work with a purpose and a team dedicated to improving lives.

Responsibilities

• Manage business processes related to risk adjustment and quality improvement across Centene’s assigned products and plans.
• Develop and implement action plans across departments affecting assigned products and plans, including workplans, issue logs, and progress reports.
• Identify and partner with various departments to implement assigned products business requirements.
• Develop and execute operational workflows for each product’s business requirements and local market dynamics.
• Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products.
• Identify and support health plan initiatives related to assigned products.
• Prepare dashboards for senior management and identify improvement opportunities.

Skills

Risk adjustment

Quality improvement

Project management

Data analysis

Education

Bachelor’s degree

Job description

Centene Corporation is seeking a detail-oriented professional to lead risk adjustment and quality improvement initiatives across assigned products and plans in PA. You will design action plans, coordinate across departments, and develop workflows that align business requirements with local market dynamics.

The role emphasizes dashboard creation for senior leadership and ongoing improvement, with a focus on healthcare accessibility and effectiveness.