HEDIS Quality Program Strategist II

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

***NOTE: This remote role will develop strategy and execute interventions start to finish to improve (mostly) HEDIS performance and other state or CMS measures, by engaging members and providers to pursue better health outcomes. Preference will be given to applicants who have experience with (1) Medicare quality improvement in either a health insurance or provider/hospital system setting, and (2) project management/process improvement.***

Position Purpose: Identify market trends and oversee functions of quality improvement programs for HEDIS or CAHPS strategy and related quality improvement activities. Assists stakeholders to determine their business issues and recommend solutions to drive business value. Analyze stakeholder business issues, formulate hypotheses and test conclusions to determine appropriate solutions.

• Conduct evaluations to assist with HEDIS gap closure or member/patient experience assess for potential pilot programs and/or process improvements to achieve sustainable quality performance goals. The assessment includes an end-to-end evaluation of the measure technical specification, performance trends, stakeholders, industry/research literature, organizational initiatives, associated policy and procedures, resources/tools. Identify opportunities for improvement and ROI.
• Collaborate and provide continued support to assigned markets to drive continued measure performance. Develop HEDIS support resources and tools to foster gap closure. Conduct ongoing assessment to determine health plan needs, collaborating with cross-functional teams to ensure successful execution.
• Monitor and ensure compliance related to state reporting, HHS and HPMS memos for quality ratings. Establish quality check policy/procedures for all member and provider communications to ensure accuracy of information, data, and alignment with Centene business goals. Establish QPS policies, procedures, and quality checks for all reoccurring departmental programs/activities, to ensure precision execution and accuracy.
• Create, maintain and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibility.

Education/Experience: Bachelor’s degree in Nursing, Public Health, Business, related field, or equivalent experience. Master’s degree preferred. 4+ years of clinical experience, managed care member/patient or health insurance experience required; 2+ years of quality experience, provider/market partnership or CAHPS experience preferred.

License/Certification: Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW), preferred; CPHQ preferred

****Additional Details:

• Department: Home State Health Quality****

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act