Manager, Quality Improvement

Centene Corp.; Northern (KY); Hybrid; USD 88,000 - 158,000; Full time

Job summary

Centene Corp. is seeking a Quality Improvement leader to oversee and enhance the organization’s QI program across healthcare operations.

The role includes guiding staff, coordinating with departments, and ensuring compliance with government standards. Qualifications include a Bachelor’s degree or equivalent experience, 3+ years in clinical/quality management, and 1 year in supervisory QI work within healthcare, preferably managed care.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 3+ years clinical, quality management or healthcare related experience.
• 1 year of recent quality improvement and supervisory experience in a healthcare environment.

Responsibilities

• Oversee and manage the functions of the quality improvement program.
• Support staff and communicate with departments to facilitate daily QI functions.
• Review and analyze reports, records and directives.
• Verify data for government program requirements and ensure compliance.
• Prepare reports on work function activities for management.
• Collaborate to document and resolve complaints as per policy.
• Monitor costs and participate in budget preparation.

Skills

Quality improvement

Healthcare experience

Provider engagement

Data analysis

Education

Bachelor's degree or equivalent experience

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Oversee and manage the functions of the quality improvement program. Providing support to staff and communicate with departments and staff to facilitate daily quality improvement (QI) functions. Review and analyze reports, records and directives. Confer with staff to obtain data such as new projects, status of work in progress, and problems encountered, required for planning work function activities. Verify data to be submitted in accordance with government program requirements and ensure compliance with state, federal and certification requirements. Prepare reports and records on work function activities for management. Oversee the review and analysis of reports.

Evaluate current procedures and practices for accomplishing the assigned work functions objectives to develop and implement improved procedures and practices and to ensure compliance with required standards. Collaborate with appropriate departments to document, investigate and resolve formal or informal complaints and appeals in accordance with Company and State policies, procedures and requirements. Monitor and analyze costs and participate in the preparation of the budget.

Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years clinical, quality management or healthcare related experience and 1 year of recent quality improvement and supervisory experience in a healthcare environment, preferably managed care.

License/Certification: Current state registered nursing license preferred. Certain states may require a formal certification in quality improvement, risk management, or another parallel field. Certified Professional in Healthcare or other licensed clinical experience preferred.

Preferred Qualifications: Experience with managed care, Medicare STARS, HEDIS, and quality improvement initiatives strongly preferred. Ideal candidates will have experience with provider engagement, gap closure strategies, electronic data submissions, supplemental data sources, flat files, and hybrid review processes. This is a remote/hybrid position, and candidates should be available to support provider outreach and engagement activities as needed.

Pay Range: $87,700.00 - $157,800.00 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.

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.

Should you need an accommodation, please email [e-mail].

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.