Teams at Centene Corporation

Leads development and implementation of healthcare quality, clinical operations, and administrative improvement programs. Oversees performance improvement projects, workflow design, root cause analysis, quality reporting, regulatory and contractual reviews, and cross-functional initiatives. Partners with clinical, operations, analytics, and market teams to improve patient outcomes and quality ratings. Requires healthcare program or project management experience, managed care knowledge, and expertise with STARS, CAHPS, HEDIS, and related quality programs.

Lead quality improvement and digital quality measurement strategy, including HEDIS, ECDS, FHIR, NCQA accreditation, risk adjustment, Medicare STARS, provider surveys, audit readiness, testing, validation, and clinical quality reporting. Establish policies, improve workflows, evaluate technology, incorporate best practices, and present performance results to senior leadership. The role requires healthcare quality management experience and collaborates across clinical, operational, and technology teams.

Analyzes healthcare encounters and claims business processes, EDI transactions, and operational data. Develops SQL queries and database tables, gathers requirements, supports user acceptance testing, troubleshoots and reconciles data, improves processes and reporting, coordinates training, updates procedures, and serves as a subject matter expert for assigned business functions.