"Alerted.org

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.

**Position Purpose:** Oversee all related activities for the Quality Improvement functions. Lead and direct process improvement activities for more efficient and streamlined workflow. Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans.

+ 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 required

Master's Degree preferred

RN license and Certified Professional in Health Care Quality preferred.

5+ years of QM/QI health care experience, including HEDIS data collection, implementing rapid-cycle process improvement principles and using study design and evaluation approaches to improve quality of care and service delivery, and knowledge of Medicaid.

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.

Responsible for the development and implementation of the Contractor’s QM/QI program in alignment with the State’s Quality Strategy (QS) and infusing continuous quality improvement approaches throughout the Contractor’s organization to improve member outcomes.

Pay Range: $168,500.00 - $320,500.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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