Quality Program Strategist II

Centene Corp.; Chicago (IL); Remote; USD 68,000 - 124,000; Full time

Job summary

A leading healthcare organization seeks a Quality Program Strategist II to manage quality improvement initiatives impacting member care. This role will involve data-driven analysis, collaboration with stakeholders, and development of programs aimed at enhancing health plan performance. Ideal candidates will have relevant clinical experience and a strong background in quality assurance.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedule

Qualifications

• 4+ years of clinical experience in managed care or health insurance required.
• 2+ years of quality experience preferred.
• Registered Nurse (RN), LPN, LVN, LCSW certification preferred.

Responsibilities

• Identify market trends and oversee quality improvement programs.
• Conduct evaluations for HEDIS gap closure and assess performance.
• Leverage data analysis for strategic recommendations.

Skills

Data analysis

Quality improvement

Stakeholder collaboration

Education

Bachelor’s degree in Nursing, Public Health, or related field

Master’s degree preferred

Job description

Quality Program Strategist II page is loaded

Quality Program Strategist II

Apply locations Remote-OR Remote-NM Remote-AZ Remote-WA Remote-CO time type Full time posted on Posted 12 Days Ago job requisition id 1573033

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: Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities. Assists stakeholders to determine their business issues and recommend solutions to drive business value. Analyze stakeholder business issues, formulate hypotheses and test conclusions to determine appropriate solutions.

• Conduct evaluations to assist with HEDIS gap closure, CAHPS and/or HOS performance and assess for potential pilot programs and/or process improvements to achieve sustainable quality performance goals.

• The assessment includes an end-to-end evaluation of the measure technical specification, performance trends, stakeholders, industry/research literature, organizational initiatives, associated policy and procedures, resources/tools.

• Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements.

• Collaborate and provide support to markets & key business stakeholders to drive continued measure performance.

• Develop HEDIS, CAHPS, and/or HOS support resources and tools to foster gap closure & improve experience for members and providers.

• Conduct ongoing assessment to determine health plan needs, collaborating with cross-functional teams to ensure successful end to end execution of strategic initiatives.

• Monitor and ensure compliance related to state reporting, HHS and HPMS memos for quality ratings.

• Establish quality check policy/procedures for all member and provider communications to ensure accuracy of information, data, and alignment with Centene business goals.

• Establish QPS policies, procedures, and quality checks for all reoccurring departmental programs/activities, to ensure precision execution and accuracy.

• Create, maintain and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibility.
• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience. Master’s degree preferred. 4+ years of clinical experience, managed care or health insurance experience required; 2+ years of quality experience preferred.

License/Certification: Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW), preferred; CPHQ preferredPay Range: $68,700.00 - $123,700.00 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

Welcome

About Us

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.