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Centene Corporation · 1 day ago

Vice President, Quality Management

United States

Full-time

Remote

Lead/Staff, Director/Executive

$172K/yr - $327K/yr

5+ years exp

Centene Corporation is transforming the health of communities one person at a time, and they are seeking a Vice President of Quality Management. This role is responsible for overseeing the quality management program for the Health Plan Division and ensuring compliance with accreditation standards and regulatory requirements.

Hospital & Health Care

H1B Sponsor Likely

Responsibilities

Leads the development and implementation of the HPD’s Quality Program and ensures national consistency of best practices for all members and providers

Acts as advisor and consultant to business unit leadership on processed and outcomes related to the accreditation program

Leads monitoring and audit preparation activities to ensure the health plan and contracted network processes are in compliance with regulatory and accreditation agencies

Leads and oversees the Delegated Oversight Department and ensures delegated provider and clinical vendor performance are in compliance

Leads and participates in national and regional committees that promote and oversee quality, accreditation programs and initiatives to monitor the quality of care, delivery and access

Ensures compliance with company standards related to clinical measurement programs transparency, data exchange, ethics and public reporting

Develops and implements provider education/intervention programs for aberrant or outlier care practices including development of clinical evidence-based clinical guidelines

Participates in the implementation of medical program strategic development and deployment in collaboration with the Medical Integration team

Programs include, but are not limited to, Wellness, Preference Sensitive Conditions, Disease State Management, Chronic Conditions and Special Populations

Works collaboratively with various HPD departments to manage health care outcomes and trends including implementing mechanisms to leverage national and local network management agreements

Leads the process to monitor the effectiveness of all quality-related programs

Oversees the design, implementation and monitoring of enterprise-wide customer satisfaction measurement and initiatives to improve the customer’s perception of services

Collaborates with national HEDIS team in the data collection process at the provider level and leads national/regional data analysis and member/provider strategy and interventions

Directs the preparation of short-term and long-range plans and budgets

Leads management of the quality team and drives staff development opportunities

Qualification

Quality ManagementManaged Care ExperienceAccreditation Standards KnowledgeClinical ExperienceRegulatory Requirements KnowledgeData AnalysisLeadership ExperienceProvider EducationCustomer Satisfaction InitiativesStaff DevelopmentClinical Guidelines DevelopmentCollaboration Skills

Required

Bachelor's Degree in a clinical science or related health care field required

5+ years managed care experience with knowledge of accreditation standards and regulatory requirements required

5+ years clinical experience required

5+ years quality management experience required

Demonstrated leadership experience in health plan operations and local delivery system

Experience with and in-depth understanding of accrediting organizations and federal and state regulations and requirements

Current, valid and unrestricted licensed clinician (e.g. LCSW, RN, MD, DO, PhD/PsyD, etc.) required

Preferred

Master's Degree preferred

Benefits

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible approach to work with remote, hybrid, field or office work schedules

Total compensation may also include additional forms of incentives

Company

Centene Corporation

Glassdoor3.7

Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives.

Founded in 1984

Saint Louis, MO, US

10001+ employees

http://www.centene.com

H1B Sponsorship

Centene Corporation has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

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2021 (1)