Senior Quality Improvement Lead: HEDIS & Compliance

Centene Corporation; Enid (OK); Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote/hybrid/office flexibility

Job summary

Centene Corporation seeks a Senior Quality Improvement Specialist to coordinate regulatory, accreditation, and clinical quality programs. You will lead large multi-plan initiatives, ensuring compliance with accreditation standards and monitoring performance to drive improvements in care delivery for members.

You will develop and implement project communications, lead committees, and create internal reports demonstrating progress to senior leadership.

Qualifications

• Bachelor’s Degree or equivalent with clinical license or Master’s in related health field.
• Minimum three years experience in a clinical/health care environment.
• Three to five years managed care experience in a health care environment.
• Experience with Medicare and/or NCQA preferred.
• Certified Professional in Health Care Quality (CPHQ) preferred.
• Valid state clinical license preferred.

Responsibilities

• Leads and manages multiple complex initiatives impacting quality of care and services.
• Ensures programs comply with accreditation, state and federal requirements.
• Develops and monitors quality improvement programs and conducts assessments to improve outcomes.
• Conducts vendor oversight and management.
• Develops activities to improve Star Ratings, HEDIS, CAHPS, HOS and other performance measures.
• Develops communication for member/physician mailings, IVR scripts, emails, and plans.

Skills

HEDIS operations experience

Clinical medical record review

Regulatory/compliance understanding

Education

Bachelor’s degree with clinical license

Master’s in health field (MPH/MPA)

CPHQ certification preferred

Job description

Centene Corporation seeks a Senior Quality Improvement Specialist to coordinate regulatory, accreditation, and clinical quality programs. You will lead large multi-plan initiatives, ensuring compliance with accreditation standards and monitoring performance to drive improvements in care delivery for members.

You will develop and implement project communications, lead committees, and create internal reports demonstrating progress to senior leadership.