Centene Corporation · 20 hours ago
Manager, Quality Improvement
United States
Full-time
Remote
Mid, Senior Level
$88K/yr - $158K/yr
4+ years expCentene Corporation is transforming the health of our communities, one person at a time. The Manager of Quality Improvement will supervise and monitor the performance of Quality Improvement staff, ensuring alignment with organizational goals and compliance with healthcare standards.
Hospital & Health Care
Responsibilities
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
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
Qualification
Required
Bachelor's degree in related field or equivalent experience
3+ years clinical, quality management or healthcare related experience
1 year of recent quality improvement and supervisory experience in a healthcare environment, preferably managed care
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
Preferred
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
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
A flexible approach to work with remote, hybrid, field or office work schedules
Company
Centene Corporation
Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives.
10001+ employees
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)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2021 (1)
Funding
Current Stage
Late StageLeadership Team
Beth Johnson
President and CEO, Coordinated Care
Clyde White
President & CEO (New Hampshire Healthy Families)
Recent News
Business Journals
2024-05-06
FierceHealthcare
2024-04-28
Company data provided by crunchbase