Centene Management Company LLC is hiring a Vice President, Quality Improvement

Centene Management Company LLC is hiring a Vice President, Quality Improvement to oversee all Quality Improvement functions and lead process improvement activities for more efficient workflow. You will be responsible for strategic initiatives that drive quality performance, revenue integrity, and compliance.

What You'll Do

• Oversee all related activities for the Quality Improvement functions.
• Lead and direct process improvement activities for more efficient and streamlined workflow.
• Oversee business processes related to risk adjustment and quality improvement for assigned products and plans.
• Be responsible for all activities related to NCQA Accreditation and/or HEDIS performance, ensuring the highest level of accreditation and health plan rating.
• Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity, and chart review.
• Insure no loss of revenue due to quality performance related to state contracts either through Pay for Quality programs or liquidated damages due to not hitting dashboard measures.
• Manage member engagement vendor, including setting performance standards and monitoring performance.
• Review and implement new technological tools and processes and foster a team concept with internal and external constituencies.
• Present results of improvement efforts and ongoing performance measures and recommend action plans to senior management.
• Manage and ensure compliance of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program as well as compliance and turnaround time of quality of care reviews.
• Be responsible for all activities related to risk adjustment performance, ensuring the highest level of return.
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines.
• Be responsible for all activities related to Risk Adjustment performance, including outreach and chart review, to ensure the highest level of return.
• Participate in, attend, and plan/coordinate staff, departmental, committee, sub-committee, community, State, and other activities, meetings, and seminars.
• Work collaboratively with Provider Performance to support the expansion of alternative payment models using HEDIS data.

What We're Looking For

• A Master's Degree in Nursing or a related clinical field, or equivalent experience.
• 10+ years of experience managing the acquisition and integration of external data sources.
• Previous management experience, including responsibilities for hiring, training, assigning work, and managing the performance of staff.

Nice to Have

• Familiarity with running risk adjustment prospective and retrospective programs.
• An RN license and Certified Professional in Health Care Quality certification.

Benefits & Compensation

• Compensation: $213,300.00 - $403,700.00 per year.
• 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.

Work Mode

This position offers a hybrid work arrangement and is open to candidates located in Iowa, Missouri, Kansas, or Nebraska.

We are 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.