Senior Quality Improvement Lead (HEDIS/NCQA)

Centene Corporation; Austin (TX); Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible work options

Job summary

Centene Corporation in the United States is seeking a Senior Quality Improvement Specialist to coordinate regulatory, accreditation, and clinical quality initiatives. The role leads large-scale programs, collaborates across regions, and ensures compliance with standards while developing performance improvement activities.

You will develop reports, communicate with stakeholders, and participate in cross-functional teams to drive Star Ratings, HEDIS, and CAHPS improvements.

Qualifications

• Bachelor’s Degree or equivalent experience with clinical license or Master’s Degree in related health field (i.e. MPH or MPA).
• Valid state clinical license preferred.
• Certified Professional in Health Care Quality (CPHQ) preferred.
• Minimum three years experience in a clinical/health care environment with related degree program.
• Three to five years managed care experience in a health care environment.
• Experience in compliance, accreditation, service or quality improvement.
• Complex project management experience.
• Experience with Medicare and/or NCQA preferred.

Responsibilities

• Leads and manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services provided to members.
• Ensures that clinical and service quality improvement programs and initiatives are compliant with applicable accreditation, state and federal requirements.
• Conducts an assessment of programs, initiatives and interventions to ensure goals and objectives were met and refine activities, as needed, to improve the effectiveness and improve outcomes.
• Conducts vendor oversight and management.
• Develops targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other identified performance measures.
• Develops and implements project-related communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas.
• Participates in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities.
• Develops internal reports to demonstrate progress on each initiative/project and presents to senior-level staff.
• Describes outreach initiatives, potential/experienced barriers and activities to resolve issues and improve outcomes.
• Leads and/or participates in multi-department/cross-functional committees and work groups which support key initiatives, prepares reports, data, agendas/minutes or other materials for committee presentation and management.
• Identifies areas of improvement within the company and works collaboratively with other departments to develop clinical and non-clinical performance improvement projects.
• Researches best practices, national and regional benchmarks, and industry standards.
• Develops collaborative relationships with contracted providers or provider groups to promote participation in quality improvement collaboratives to improve clinical care outcomes.
• May lead and/or participate in external activities, work groups or committees when applicable.
• Communicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures.
• Develops and/or maintains relationships with other external organizations to expand key partnerships.
• Assesses current industry trends and regulations for enterprise-wide adoption to assure quality and effectiveness of health care delivery and/or healthcare services provided to members.
• Performs all other duties as assigned.
• Performs other duties as assigned
• Complies with all policies and standards

Skills

HEDIS Operations

Clinical Medical Record Review

Education

Bachelor’s Degree or equivalent with clinical license

Master’s Degree in MPH or MPA or related health field

CPHQ certification

Valid state clinical license

Job description

Centene Corporation in the United States is seeking a Senior Quality Improvement Specialist to coordinate regulatory, accreditation, and clinical quality initiatives. The role leads large-scale programs, collaborates across regions, and ensures compliance with standards while developing performance improvement activities.

You will develop reports, communicate with stakeholders, and participate in cross-functional teams to drive Star Ratings, HEDIS, and CAHPS improvements.