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PA Health & Wellness · 1 day ago

Director, Quality Program Strategy

Pennsylvania, United States

Full-time

Hybrid

Director/Executive

$113K/yr - $209K/yr

7+ years exp

PA Health & Wellness is part of Centene, a national organization focused on transforming community health. The Director of Quality Program Strategy will lead the development and management of quality programs and improvement initiatives, ensuring compliance with quality measures and enhancing care delivery for members.

FitnessHealth CareWellness

Comp. & Benefits

Responsibilities

Oversee aspects of the company quality measure improvement outreach strategy including the execution of function for all markets and products

Direct quality measures portfolio management for all products through development and execution of best practices towards achieving market and product quality and risk goals

Serve as subject matter expert in measure development and methodology

Define business requirements and strategies for data capture to close risk and care gaps

Perform root cause analysis, failure mode, and effective analysis and identify opportunities to mitigate future risks

Plan and direct programs, and initiatives related to HEDIS Stars and quality ratings systems, Medicaid pay for performance, accreditation targets and HOS improvement and gap closure

Communicate risk, organizational impact and progress towards achieving goals to executive leadership

Identify Market and Product strengths, weaknesses, opportunities and threats

Develop work process for supplemental data capture in compliance with HEDIS technical specifications

Qualification

Quality improvementHEDIS operationsRisk AdjustmentQuality rating systemsMedicare productsMedicare StarsRoot cause analysisData captureCommunicationLeadership

Required

Bachelor's degree in Nursing, related clinical degree or equivalent experience

7+ years of healthcare related experience including quality improvement, HEDIS operations, and Risk Adjustment

Experience with quality rating systems, Medicare products, Medicare Stars, and Marketplace products

Preferred

Experience with PA health plans is highly preferred

Previous experience working in a managed care setting is highly preferred

Current state's RN license preferred

Benefits

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off plus holidays

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

Company

PA Health & Wellness

Established to deliver quality healthcare in the state of Pennsylvania through local, regional and community-based resources, PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation (Centene).

Founded in 2016

Camp Hill, Pennsylvania, USA

501-1000 employees