[Hiring] Director, Quality Improvement @Centene Corporation

Role Description

Lead and direct process improvement activities that provide more efficient and streamlined workflow.

• Must reside in Indiana or be willing to relocate to Indiana.
• Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance.
• Responsible for quality improvement aspects of risk adjustment processes for all products.
• Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS).
• Oversee provider satisfaction surveys and implement action plans for improvements.
• Research and incorporate best practices into operations.
• Organize and control activities, methods, and procedures to achieve business objectives.
• Review and implement new technological tools and processes and foster team concept with internal and external constituencies.
• Present results of improvement efforts and ongoing performance measures to senior management.
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines.
• Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities and reduce the cost of care.
• Work closely with State, County and local agencies, community stakeholders and communities to monitor the application of all standards.
• Promote an environment of cultural competence throughout the health plan through identification and implementation of culturally-inclusive best practices and innovations.
• Oversee the assessment of cultural diversity of the provider network to identify resources and gaps.
• Monitor and evaluate provider practices through KPIs within health equity dashboards.
• Oversee the population specific activities, including cultural treatment teams and other cultural community support system activities.
• Oversee the comprehensive, outcomes-based Cultural Competency Plan that is aligned with CLAS standards and national and regional priorities/initiatives.
• Manage outreach budget for Cultural Competency programs and sponsorships.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Bachelor's Degree in Nursing, other related field or equivalent experience required.
• Master's Degree preferred.
• 7+ years of quality management, quality improvement or healthcare operations experience required.

Requirements

• Certain states may require a formal certification in quality improvement, risk management, or another parallel field.
• Current state’s RN license preferred.
• Certified Professional in Health Care Quality preferred.

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.