Senior Quality Program Development Manager

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: Interacts extensively with Quality Improvement leadership and leaders of collaborative organizations. Functions as a lead program development manager in collaboration with Quality, Population Health Services, and all other Operations business owners or cross-functional work groups in the development and implementation of efficient and effective standards, policy and procedures, work flows, and decision support systems to support ongoing improvements of clinical and administrative operations. Directs and facilitates quality improvement program development and implementation for innovations in new or specialized populations.

• Oversees the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration.
• Designs and facilitates the development of various programs/systems, work flows, and integration efforts in alignment with Corporate, market, contractual, regulatory and quality requirements.
• Acts as the content and technical subject matter expert to the operating managers for key project initiatives including the development of detailed work plans, facilitating root cause analysis, identifying and socializing process enhancements, setting deadlines, assigning responsibilities, and monitoring/summarizing project progress.
• Prepares strategic analysis of potential business and/or operational opportunities in relation to new business, rebids, and QI targets using customized solutions.
• Conducts needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner.
• Partners with leaders and members of the Quality Analytics and Quality Improvement Teams and determines data needs as well as assists in designing tools and reports as necessary
• Leads clinical and operations staff with consulting and analysis services to support initiatives intended to achieve breakthrough or incremental process improvement in patient quality of care
• Analyzes, updates, and modifies business practices and programs to continually improve quality of services and plan operations
• Develops strategies for special program participation and Quality Improvement.
• Develops systems for close coordination of QI related functions with departments whose activities are directly a part of the QI Program
• Collects and summarizes program performance data, identifies opportunities for improvement, and presents findings and recommendations to leadership
• Conducts PDSA analyses on pilot programs to determine repeatability and scalability and presents findings to leadership
• Develops program evaluation methodologies for use by functional areas on quality programs
• Presents program proposals and findings at market QI committees as requested
• Leads interaction with external partners for quality program development including State agencies, vendors, and community stakeholders
• Provides guidance and training to new Quality team associates
• Conducts other responsibilities as needed.

Candidate Education: Required A Bachelor's Degree in a related field. Required or equivalent work experience Business, HC Management, or Nursing. Preferred A Master's Degree in a related field Business or HC Management (MBA, MHA, MPH, MSN)

Candidate Experience: Required 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment. Required 5+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH
Required 2+ years of experience in design, develop and implement enterprise quality related programs (including CAHPS, HEDIS, Stars, and State QI Programs) across a variety of settings including: defining the eligible population, service mix, delivery system configuration and financing; integration of behavioral, clinical, social, and community health care for members with multiple chronic conditions; working with multiple market leaders to coordinate consistent quality initiatives; conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide.

Licenses and Certifications: Preferred Six Sigma Certification
Preferred Lean Certification: Preferred Certified Professional in Healthcare Quality (CPHQ)
Please note: this position will require occasional travel to offices within the state of NY.

Pay Range: $86,000.00 - $154,700.00 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.  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