Remote Senior Quality Improvement Specialist (HEDIS/CAHPS)

Centene Corporation; Florida; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off & holidays

Remote/hybrid work options

Job summary

Centene Corporation seeks a Senior Quality Improvement Specialist to lead multiple health-services initiatives across national programs. You will coordinate regulatory and accreditation activities, develop improvement plans, and monitor performance to ensure compliance with standards.

The role emphasizes collaboration with regional teams, vendor oversight, and communication of results to senior leadership. A clinical background and experience with Medicare/NCQA are preferred.

Qualifications

• Bachelor's degree or equivalent experience; clinical license preferred.
• CPHQ certification preferred.
• 3+ years in a clinical/healthcare setting with related degree program.
• Medicare and/or NCQA experience preferred.

Responsibilities

• Leads and manages multiple complex initiatives impacting quality and effectiveness of care.
• Ensures programs comply with accreditation, state and federal requirements.
• Conducts assessments to improve outcomes and refine activities as needed.
• Performs vendor oversight and management.
• Develops activities to improve Star Ratings, HEDIS, CAHPS, HOS and other measures.
• Creates and maintains project communications and minutes for leadership reviews.
• Maintains annual quality improvement documents, audits and policies.
• Develops internal reports and presents progress to senior staff.
• Collaborates across departments to identify improvement opportunities.
• Engages with providers to promote participation in quality collaboratives.

Skills

HEDIS Operations

Medical Record Review

Regulatory Compliance

Quality Improvement

Vendor Oversight

Cross-Department Collaboration

Education

Bachelor's degree or equivalent

Clinical license preferred

Master's in health field (MPH/MPA) preferred

Job description

Centene Corporation seeks a Senior Quality Improvement Specialist to lead multiple health-services initiatives across national programs. You will coordinate regulatory and accreditation activities, develop improvement plans, and monitor performance to ensure compliance with standards.

The role emphasizes collaboration with regional teams, vendor oversight, and communication of results to senior leadership. A clinical background and experience with Medicare/NCQA are preferred.