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Quality Program Strategist

Centene Corporation • Remote • Posted 21 days ago

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Remote • Full-time • $54,000-$97,100/yr • Mid Level

Job Highlights

Using AI ⚡ to summarize the original job post

The Quality Program Strategist at Centene Corporation is responsible for planning, organizing, and monitoring quality-related projects to deliver defined requirements and meet company strategic objectives. This role involves supporting enterprise-wide quality initiatives, creating quality risk assessments, utilizing Lean 6 Sigma methodologies, and facilitating quality improvement training. The position is remote and requires candidates to be located in either the eastern or central time zones. Experience in improving Medicare Advantage, Dual CMS Stars Quality, and Member Experience measures is essential, along with proficiency in analytical tools and quality improvement techniques.

Responsibilities

  • Support enterprise-wide quality initiatives by analyzing and researching potential issues within quality metrics and goals of health plan programs.
  • Recommend quality improvements to achieve goals, including updates to programs and processes.
  • Create quality risk assessments and develop processes for health plans to achieve quality metrics.
  • Utilize Lean 6 Sigma methodologies to identify potential problems and resolutions with enterprise-wide priority metrics.
  • Collaborate through ad hoc initiative requests and scorecard review to support initiative development and implementation.
  • Create, maintain and facilitate quality improvement health plan training.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Qualifications

Required

  • Associate's degree in Nursing, Public Health, or related clinical field, or equivalent experience.
  • 2+ years clinical experience or managed care.
  • Health insurance experience.
  • Experience with CMS MA and DSNP technical specifications.
  • Solid understanding of CMS MA Star and DSNP ratings and strategies to improve performance.
  • Intermediate proficiency with analytical tools (e.g., Excel).
  • Ability to create and maintain key presentations.
  • Proficient use of Quality Improvement tools (e.g., Root Cause Analysis).

Preferred

  • Registered Nurse, Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker.
  • CPHQ certification.

About Centene Corporation

Centene Corporation is a leading healthcare enterprise in the United States, specializing in managed healthcare products and services primarily through Medicaid, Medicare, and commercial products. They offer healthcare coverage through managed care plans that include medical, behavioral, and specialty services, aiming to improve health outcomes for underserved populations. Operating on a global scale, Centene has a significant presence in over 30 states and continues to grow through strategic expansions and partnerships, such as acquiring WellCare Health Plans in 2020.

Full Job 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.

**Position Purpose:** Plans, organizes, and monitors quality related projects to deliver defined requirements and meet company strategic objectives.

+ Support enterprise-wide quality initiatives by analyzing and researching potential issues within quality metrics and goals of health plan programs, including the determination of the appropriate target population, health program design, marketing of the program, and data systems; recommend quality improvements to achieve goals, including updates to programs and processes

+ Create quality risk assessments and develop processes for health plans to achieve quality metrics

+ Utilize Lean 6 Sigma methodologies to identify potential problems and resolutions with enterprise-wide priority metrics

+ Collaborate through ad hoc initiative requests and scorecard review and to support initiative development and implementation

+ Create, maintain and facilitate quality improvement health plan training

+ Performs other duties as assigned

+ Complies with all policies and standards

**This is remote positions for candidates located in eastern or central time zones. Ideal candidate will have experience improving Medicare Advantage (MA), Dual CMS Stars Quality and Member Experience measures to an overall 4 star or above. Intermediate proficiency with analytical tools (e.g., Excel), ability to create and maintain key presentations, and proficient use of Quality Improvement tools (e.g., Root Cause Analysis). Experience with CMS MA and DSNP technical specifications and solid understanding of CMS MA Star and DSNP ratings and strategies to improve performance.**

**Education/Experience:** Associate's degree in Nursing, Public Health, or related clinical field, or equivalent experience. 2+ years clinical experience or managed care. Health insurance experience required; 1+ year quality experience preferred.

**License/Certification:** Registered Nurse, Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker preferred; CPHQ preferred

Pay Range: $54,000.00 - $97,100.00 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