Quality Program Strategist II

Carolina Complete Health; Mount Holly (NC); On-site; USD 68,000 - 124,000; Full time

Job summary

A leading health organization is seeking a Quality Program Strategist II to oversee quality improvement programs and analyze stakeholder business issues. The ideal candidate will have a strong background in clinical experience and quality assurance, with a focus on enhancing member and provider experiences through data-driven strategies.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work options

Qualifications

• 4+ years of clinical experience, managed care, or health insurance experience required.
• 2+ years of quality experience preferred.
• Registered Nurse (RN) or equivalent preferred.

Responsibilities

• Identify market trends and oversee functions of quality improvement programs.
• Conduct evaluations to assist with HEDIS gap closure and assess potential pilot programs.
• Leverage data analysis to derive actionable insights and 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

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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.

Must reside in North Carolina.

Position Purpose:

Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities. Assist stakeholders in determining 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 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, policies, procedures, resources/tools.
• Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements.
• Collaborate and support 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 policies/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 recurring departmental programs/activities to ensure precision execution and accuracy.
• Create, maintain, and facilitate training for Quality Improvement Health Plan staff as applicable.
• Perform other duties as assigned.
• Comply with all policies and standards.

Education/Experience:

Bachelor's degree in Nursing, Public Health, or a 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 preferred.

Pay 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 flexible work options (remote, hybrid, field, or office schedules). Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered per applicable laws.

Additional Details:

• Job Industries: Other
• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Business Development and Sales
• Industries: Hospitals and Health Care

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