[Hiring] Quality Improvement Manager @Centene Corporation

Role Description

Applicants for this job have the flexibility to work remote from home anywhere in the United States. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

• Oversee and manage the functions of the quality improvement program.
• Lead the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team.
• Provide support to staff and communicate with departments and staff to facilitate daily quality improvement functions.
• Serve as key escalation point for Health Plans, auditors, and internal partners.
• Oversee state HEDIS and regulatory reporting programs and state-specific audit requirements.
• Review and analyze reports, records, and directives.
• Confer with staff to obtain data such as new projects, status of work in progress, and problems encountered.
• Verify data to be submitted in accordance with government program requirements and ensure compliance with state, federal, and certification requirements.
• Prepare reports and records on work function activities for management.
• Oversee the review and analysis of reports.
• Evaluate current procedures and practices to develop and implement improved procedures and practices.
• Collaborate with appropriate departments to document, investigate, and resolve formal or informal complaints and appeals.
• Monitor and analyze costs and participate in the preparation of the budget.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 3+ years clinical, quality management, or healthcare-related experience.
• 1 year of recent quality improvement and supervisory experience in a healthcare environment, preferably managed care.
• Strong knowledge of HEDIS, NCQA requirements, Medicaid quality reporting, and healthcare regulatory submissions strongly preferred.
• Experience leading complex audit or regulatory programs with multiple concurrent deadlines highly preferred.

Requirements

• Certain states may require a formal certification in quality improvement, risk management, or another parallel field.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• 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.
• Benefits may be subject to program eligibility.