Manager, Quality Improvement

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 IS REMOTE***

Position Purpose:

Supervise and monitor the performance of Quality Improvement staff who support outreach efforts of the Quality Solutions Outreach (QSO) team to include quality audits, learning and development and business analytics.

• Provide a high degree of involvement and awareness of all QSO programs to ensure alignment of the support staff and the needs of the team to aid in the creation of processes and strategy.
• Managing diverse staff; execute corporate function effectively; ability to communicate professionally and with cultural sensitivity.

• Review and analyze reports, records and directives.
• Collect, analyze, and summarize data to prepare reports and make recommendations. Research and use best practices to achieve effective project implementation and outcomes.
• Confer with staff to obtain data such as new projects, status of work in progress, and problems encountered, required for planning work function activities. Verify data to be submitted in accordance with government program requirements and ensure compliance with state, federal and certification requirements.
• Follow organization standards to maintain quality service. Identify obstacles in the call handling process and effectively prevent, resolve and overcome those obstacles.
• Monthly audits of outbound member and provider engagement
• Prepare reports and records on work function activities for management.
• Oversee the review and analysis of reports.
• All educational needs from onboarding through continuous learning needs for all QSO programs
• Identify the training needing to improve performance and provide assistance to Retention Management to ensure consistent levels of service.
• Evaluate current procedures and practices for accomplishing the assigned work functions objectives to develop and implement improved procedures and practices and to ensure compliance with required standards.
• Collaborate with appropriate departments to document, investigate and resolve formal or informal complaints and appeals in accordance with Company and State policies, procedures and requirements.
• Monitor and analyze costs and participate in the preparation of the budget.
• Hiring, training, evaluating, and administering performance management; and monitoring and directing workflow to meet organizational objectives and requirement
• Investigate exploitation of infrastructure tools to optimize productivity and performance.
• Monitor and analyze costs and participate in the preparation of the budget.
• Strong knowledge of Managed Care and Health Insurance concepts and regulation.
• Proficiency in Microsoft Office: Excel, Word, Access; Lotus Notes; Internet.
• Knowledge of various quality programs, including measures associated with HEDIS.
• Ability to lead or coordinate projects within own department.
• Business Analysis Knowledge: Skilled to work in a fast paced environment. Must have strong analytical and problem solving skills.
• Customer Service: Skilled to communicate with all levels of Management, internal and external customers.

Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years clinical, quality management or healthcare related experience and 1 year of recent quality improvement and supervisory experience in a healthcare environment, preferably managed care.
License/Certification: Current state registered nursing license preferred. Certain states may require a formal certification in quality improvement, risk management, or another parallel field. Certified Professional in Healthcare or other licensed clinical experience preferred.

Pay Range: $87,700.00 - $157,800.00 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