Chicago, Illinois

Position Purpose:

  • Develop and implement the infrastructure to support the medical management quality improvement strategic and operating plans resulting in improved quality outcomes for HEDIS and STARS across all health plans.
  • Support the health plan efforts to attain and maintain excellent NCQA accreditation status, achievement of health benefit ratio targets and reduction in administrative costs
  • Oversee the development and implementation of processes to support enterprise and health plans accreditation, quality improvement and grievance and appeals functions
  • Develop and facilitate implementation of business processes that are scalable and aimed at increasing effectiveness and efficiency, while ensuring compliance with NCQA, state and federal guidelines, and health plan requirements
  • Drive adoption of best practices and standardization within the organization while developing customized approaches when appropriate for unique markets and products
  • Facilitate a continuous process improvement environment to challenge existing processes and strive for operational excellence
  • Develop and implement standardization in measuring and monitoring quality outcome metrics
  • Develop and implement a consistent methodology to evaluate pilots, programs and processes to facilitate quality improvement

Education/Experience: Bachelor's degree in Nursing or related field. 10+ years of quality improvement or quality management experience. Strong operational and analytical skills. Six Sigma experience preferred.

Licenses/Certifications: Current state’s RN license

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.

Chicago, Illinois

Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans). The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.

Similar jobs