[Hiring] Director, Quality & Process Improvement, HEDIS Audit @Centene Corporation

Role Description

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.

• Lead and direct process improvement initiatives by utilizing process improvement methodologies in the analysis of current operations and design of improvement projects across all areas that impact operations.
• Support NCQA HEDIS audit readiness and compliance, ensuring accurate and timely submissions.
• Lead daily audit readiness activities, including:
  • Roadmaps
  • Section 5 documentation
  • Measure Specifications
  • CAHPS coordination
  • Auditor engagement
• Oversee the administration, coordination, and evaluation of quality assurance and training, including:
  • Policy and procedure development
  • Training assessments
  • Quality adherence auditing
• Direct the execution of performance improvement projects, including process mapping and process design, including HEDIS audit timelines and deliverables.
• Serve as primary point of contact for auditors and leadership, supporting audit communications and successful outcomes.
• Create and maintain dashboards, communications, and strategies to improve effectiveness.
• Research and develop best practices, policies, procedures, and goals in compliance with internal and external guidelines.
• Oversee data analysis and gathering processes and programs to establish costs and benefits of process effectiveness and efficiency.
• Ensure business unit is compliant with URAC and Joint Commission Accreditation standards.
• Review and implement new technological tools and processes.
• Establish strong collaborative relationships with all functional units and their leaders.

Qualifications

• Bachelors Degree in related field.
• 6+ years of quality and process improvement experience.
• Healthcare industry experience preferred.
• Knowledge of research methodologies including measures and outcomes.
• Knowledge of process mapping, process design, and workflow management software and applications.
• URAC and Joint Commission Accreditation experience preferred.
• Experience with NCQA HEDIS measures or audit processes highly preferred.

Requirements

• Pay Range: $118,400.00 - $219,000.00 per year.

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

Company Description

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.