Centene Corporation · 14 hours ago

Quality Program Strategist II - Marketplace

Pennsylvania, United States

Full-time

Remote

Mid Level

$67K/yr - $121K/yr

4+ years exp

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Responsibilities

Conduct evaluations to assist with HEDIS gap closure, CAHPS and/or HOS performance and assess for potential pilot programs and/or process improvements to achieve sustainable quality performance goals.

The assessment includes an end-to-end evaluation of the measure technical specification, performance trends, stakeholders, industry/research literature, organizational initiatives, associated policy and procedures, resources/tools.

Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements.

Collaborate and provide support to markets & key business stakeholders to drive continued measure performance.

Develop HEDIS, CAHPS, and/or HOS support resources and tools to foster gap closure & improve experience for members and providers.

Conduct ongoing assessment to determine health plan needs, collaborating with cross-functional teams to ensure successful end to end execution of strategic initiatives.

Monitor and ensure compliance related to state reporting, HHS and HPMS memos for quality ratings.

Establish quality check policy/procedures for all member and provider communications to ensure accuracy of information, data, and alignment with Centene business goals.

Establish QPS policies, procedures, and quality checks for all reoccurring departmental programs/activities, to ensure precision execution and accuracy.

Create, maintain and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibility.

Performs other duties as assigned

Complies with all policies and standards.

Qualification

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HEDISCAHPSQuality ImprovementData AnalysisManaged CareHealth InsurancePublic HealthClinical ExperienceCPHQ CertificationTraining Development