Senior Quality & Risk Practice Leader (Remote)

Centene Management Company LLC; Oklahoma; Hybrid; USD 87,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangement: remote,hyBr

A flexible approach to work withremote

Job summary

Centene Management Company LLC seeks a leader to direct clinical, quality, and risk adjustment functions within a managed care setting. You will develop physician education programs, analyze health data, and supervise a team to improve member care while reducing costs and identifying risks.

You will coordinate across departments, maintain quality tracking systems, and ensure regulatory and contract compliance. Strong experience in managed care and relevant certifications are preferred.

Qualifications

• Bachelor's degree required; 3+ years of supervisory/management experience.
• 5+ years' experience in a managed care environment.
• Certified RN, CHRM, Foreign MD, or AAPC certification preferred.

Responsibilities

• Provide leadership and direction for clinical, quality, and risk adjustment functions.
• Develop and oversee clinical programs for physician education and team development.
• Analyze reports to identify trends, opportunities and recommend actions.
• Coordinate with other departments to prioritize provider engagement and communications for clinical projects.
• Maintain tracking systems for health care quality improvement per regulatory requirements and contracts.
• Monitor high-risk, high-volume, and unusual events and manage performance evaluations.
• Provide guidance, training, and development to department associates.
• Coordinate external oversight visits and ensure timely corrective action follow-ups.

Skills

Leadership

Healthcare quality

Risk adjustment

Data analysis

Program development

Education

Bachelor's degree in Health Care, Nursing, Public Health Administration or Business, or equivalent

Job description

Centene Management Company LLC seeks a leader to direct clinical, quality, and risk adjustment functions within a managed care setting. You will develop physician education programs, analyze health data, and supervise a team to improve member care while reducing costs and identifying risks.

You will coordinate across departments, maintain quality tracking systems, and ensure regulatory and contract compliance. Strong experience in managed care and relevant certifications are preferred.