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: Ensures the Medicare Enterprise Quality results aligned with the 5-year CNC Strategic Plan. Develops short and long terms strategies to address quality performance gaps to support Medicare businesses. Directs, develops, and implements the core processes of performance strategies and programs across all markets and lines of business to include corporate shared service teams.
Oversees all aspects of the company’s quality measure improvement strategies including the execution of function for all markets and lines of business
Directs quality measures portfolio management for all Medicare products through development and execution of best practices towards achieving market and product quality and risk goals.
Serves and subject matter expert in measure development and methodology. Defines business requirements and strategies for data capture to close risk and care gaps.
Plans and directs programs, and initiatives related to STARS measures and, accreditation targets and Administration /Operations, Pharmacy, Clinical-HEDIS, CAHPS/HOS improvement and gap closure.
Performs root cause analysis, failure mode, and effective analysis and identify opportunities to mitigate future risks.
Communicates risks, organizational impact and progress towards achieving goals to leadership.
Identifies market and product strengths, weaknesses, opportunities, and threats.
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Bachelor’s degree in Business Administration, Management, Finance, Accounting, Medical Economics, Statistics, HealthCare Administration, or related field. 8+ years of experience in population health, healthcare, HEDIS, HOS, CAHPS, STARS or QRS. Managed care experience in a HMO, MSO or provider managed care setting, specifically with state and federal health programs. 3+ years of supervisor/management experience. Strong financial and analytical background. Strong understanding of the managed care and Medicare, Medicaid and Marketplace products and quality rating systems. Strong understanding of Quality and Risk Adjustment and value-based care programs. Strong understanding of Medicare, Medicaid, and Marketplace payer landscapes. Ability to effectively negotiate.Pay Range: $142,300.00 - $263,500.00 per yearCentene 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