Quality Program Strategist II

Carolina Complete Health; Troutman (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 drive business value through data analysis and stakeholder collaboration. This role requires strong clinical experience and offers a competitive salary with comprehensive benefits, including health insurance and flexible work arrangements.

Benefits

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Holidays

Flexible work arrangements

Qualifications

• 4+ years of clinical, managed care, or health insurance experience.
• 2+ years in quality preferred.
• Licenses such as RN, LPN, LVN, or LCSW preferred.

Responsibilities

• Conduct evaluations for HEDIS gap closure and performance assessment.
• Leverage data analysis for performance improvements.
• Collaborate with stakeholders to drive measure performance.

Skills

Data analysis

Quality improvement

Education

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

Master's degree

Job description

Join to apply for the Quality Program Strategist II role at Carolina Complete Health.

4 days ago Be among the first 25 applicants.

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.

Responsibilities:

1. 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.
2. Perform end-to-end evaluation of measure technical specifications, performance trends, stakeholders, industry/research literature, organizational initiatives, policies, procedures, resources, and tools.
3. Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements.
4. Collaborate with markets and key stakeholders to drive measure performance.
5. Develop support resources and tools for HEDIS, CAHPS, and/or HOS to foster gap closure and improve member and provider experiences.
6. Assess health plan needs continuously, collaborating with cross-functional teams to ensure successful execution of strategic initiatives.
7. Monitor compliance related to state reporting, HHS, and HPMS memos for quality ratings.
8. Establish quality check policies/procedures for member and provider communications to ensure accuracy and alignment with business goals.
9. Create and maintain training for Quality Improvement staff related to assigned responsibilities.
10. Perform other duties as assigned and ensure compliance with policies and standards.

Qualifications:

• Bachelor's degree in Nursing, Public Health, or related field; Master's preferred.
• 4+ years of clinical, managed care, or health insurance experience; 2+ years in quality preferred.
• Licenses such as RN, LPN, LVN, or LCSW are preferred; CPHQ certification is also preferred.

Additional Details:

Pay Range: $68,700 - $123,700 per year.

Centene offers comprehensive benefits, including health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements.

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.