Quality Improvement Project Manager

Remote Jobs; United States; Hybrid; USD 70,000 - 126,000; Full time

Job summary

Centene is seeking a Quality Improvement and Project Management professional to coordinate and monitor initiatives from inception to closure, including NCQA/HEDIS preparation. You will provide expertise across plan staff and conduct educational sessions, while coordinating work plans and resources for HEDIS/CAHPS submissions to NCQA.

You will analyze data, develop presentations for committees, and design data reviews to ensure accuracy and regulatory compliance.

Qualifications

• Bachelor's degree in Healthcare, Business or equivalent experience.
• Master's in Public Health or related field preferred.
• 4+ years of quality improvement or project management experience in managed care with advanced knowledge of HEDIS and NCQA.
• Proficiency in Microsoft applications including PowerPoint, Excel and Access.

Responsibilities

• Coordinate and monitor quality improvement and organizational projects from inception to closure including NCQA and HEDIS preparation.
• Provide functional and technical knowledge for NCQA/HEDIS across plan staff and deliver educational sessions.
• Coordinate work plans, teams and resources for HEDIS/CAHPS submission to NCQA.
• Analyze data and develop presentations and materials for committees and newsletters.
• Design, run and manage the data review process to ensure data accuracy and regulatory compliance.
• Coordinate and implement interventions to improve HEDIS, CAHPS and health measures for the Plan.
• Support NCQA accreditation maintenance and corporate compliance coordination.
• Maintain project deliverables, including design documents, test plans and operations documentation.

Skills

Quality improvement

Project management

HEDIS knowledge

NCQA knowledge

Microsoft PowerPoint

Microsoft Excel

Microsoft Access

Education

Bachelor's degree in Healthcare or Business

Master's in Public Health or related field preferred

Tools

PowerPoint

Excel

Access

Job description

Position Purpose:

Coordinate and monitor quality improvement and organizational projects from inception to closure including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) preparation.

• Provide functional and technical knowledge for NCQA/HEDIS across all plan departmental staff and deliver educational sessions to internal staff and external constituents as needed.
• Coordinate Work Plan, team and resources for HEDIS/Consumer Assessment of Healthcare Providers and Systems (CAHPS) submission to Connector Authority and NCQA.
• Analyze data and develop presentations and materials for committee and articles for newsletters and other educational pieces.
• Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
• Coordinate and implement interventions to increase HEDIS, CAHPS and designated health measures for the Plan.
• Adhere to NCQA standards and work with Corporate Director of Accreditation in maintaining Plan's NCQA accreditation.
• Support the coordination of corporate compliance and external surveys as needed.
• Monitor the creation of all project deliverables to ensure adherence to standards including design documents, test plans and operations documentation.
• Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure.
• Coordinate all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects with department staff and corporate contacts. Evaluate sources for alternative data capture; assess ongoing methodology and results.
• Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans.

Education/Experience:

Bachelor's degree in Healthcare, Business or equivalent experience. Master's in Public Health or related field preferred. 4+ years of quality improvement or project management experience in managed care with advanced knowledge of HEDIS and NCQA. Proficiency required in Microsoft applications including PowerPoint, Excel and Access.

Pay Range: $70,100.00 - $126,200.00 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

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

*Qualified candidates must reside in the state of Florida*

Registered Nurse (RN), Licensed Practical Nurse, Licensed Clinical Social Worker (LCSW) or CPHQ certification highly preferred