Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
- Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation
- Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review
- 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 and recommend actions plans to senior management
- Research and incorporate quality improvement best practices into operations
- Organize and control activities, methods, and procedures to achieve business objectives
- Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
- Manage and ensure compliance of EPSDT program as well as compliance and turnaround time of grievances and appeals
Education/Experience: Bachelor's degree in Nursing or related clinical field or equivalent experience. Master's' degree preferred. 10+ years of healthcare operations experience, including quality improvement and NCQA accreditation experience. Experience managing acquisition and integration of external data sources. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Familiarity with running Risk Adjustment prospective and retrospective programs preferred
License/Certification: RN license and Certified Professional in Health Care Quality preferred.
Pay Range: $178,500.00 - $338,800.00 per year 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
