Senior Quality Improvement Lead - HEDIS/Star Ratings Remote

Centene Management Company LLC; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Job summary

Centene is seeking a Senior Quality Improvement Specialist to coordinate regulatory, accreditation and clinical quality initiatives across health plans. You will lead multi-site programs, oversee vendor relationships, and drive improvements in Star Ratings, HEDIS, CAHPS, and related measures.

Responsibilities include developing reports, training staff, and ensuring compliance with state and federal requirements while collaborating with internal teams and external providers.

Qualifications

• Bachelor’s degree or equivalent with clinical license or Master’s degree in related health field (MPH/MPA)
• CFHQ certification preferred
• Minimum three years in clinical/healthcare environment with related degree
• Three to five years of managed care experience in healthcare
• Experience with Medicare and/or NCQA preferred

Responsibilities

• Coordinate assigned regulatory, accreditation, clinical quality and service improvement programs.
• Lead complex initiatives impacting quality and effectiveness of care.
• Develop and monitor program performance for compliance.
• Conduct vendor oversight and management.
• Improve Star Ratings, HEDIS, CAHPS, HOS and provider satisfaction measures.
• Create communication materials and maintain meeting records.
• Participate in cross-functional committees and present findings to leadership.
• Identify improvement opportunities and collaborate with departments to implement projects.

Skills

HEDIS operations experience

Clinical quality improvement

Regulatory/compliance knowledge

Vendor oversight

Education

Bachelor’s or Master’s in a health-related field (e.g., MPH/MPA)

CPHQ certification (preferred)

Tools

CPHQ certification

Job description

Centene is seeking a Senior Quality Improvement Specialist to coordinate regulatory, accreditation and clinical quality initiatives across health plans. You will lead multi-site programs, oversee vendor relationships, and drive improvements in Star Ratings, HEDIS, CAHPS, and related measures.

Responsibilities include developing reports, training staff, and ensuring compliance with state and federal requirements while collaborating with internal teams and external providers.