Remote Senior Quality Improvement Specialist: HEDIS & NCQA

Centene Corporation; South Carolina; Hybride; USD 70 000 - 126 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K plan

Stock purchase plan

Tuition reimbursement

Paid time off & holidays

Flexible work schedules

Résumé du poste

Centene Corporation is seeking a Senior Quality Improvement Specialist to coordinate regulatory, accreditation and clinical quality programs. This role leads large-scale initiatives, partnering across national, regional and multi-plan teams to improve care quality and member outcomes.

The ideal candidate will have 3+ years of clinical/healthcare experience, strong project management skills, and knowledge of Medicare/NCQA standards.

Qualifications

• Experience in clinical/healthcare quality initiatives.
• Knowledge of accreditation and regulatory requirements.
• Ability to manage complex programs and projects.

Responsabilités

• Leads multiple complex quality initiatives affecting care delivery.
• Ensures programs comply with accreditation and regulatory standards.
• Assesses programs and interventions to improve outcomes.
• Oversees vendor management and performance.
• Develops activities to improve Star Ratings, HEDIS, CAHPS, and related metrics.
• Creates communications for members, physicians, and stakeholders.
• Maintains quality improvement documents, audits, and procedures.
• Generates internal reports and presents progress to senior staff.
• Identifies barriers and develops actions to resolve issues.
• Leads cross-functional committees and projects.
• Collaborates across departments to enhance performance.
• Researches best practices and industry benchmarks.
• Builds provider partnerships for quality improvement initiatives.
• Engages in external activities when applicable.
• Communicates program results to external entities.
• Expands partnerships with external organizations.

Connaissances

HEDIS experience

Clinical record review

Quality improvement

Healthcare regulations

Formation

Bachelor's degree or equivalent with clinical license

Master's degree in related health field (MPH/MPA)

CPHQ certification

Description du poste

Centene Corporation is seeking a Senior Quality Improvement Specialist to coordinate regulatory, accreditation and clinical quality programs. This role leads large-scale initiatives, partnering across national, regional and multi-plan teams to improve care quality and member outcomes.

The ideal candidate will have 3+ years of clinical/healthcare experience, strong project management skills, and knowledge of Medicare/NCQA standards.