Quality Improvement Project 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: Develop programs and materials for specific provider networks to engage, recommend and support improved coding for direct impact on HEDIS data capture strategies in accordance with National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) standards and specifications. Provide insight and make recommendations to internal stakeholders on intervention opportunities.

*Note: Qualified candidates need to reside in California.

• Develop programs and materials for improved data capture to close HEDIS data gaps.

• Provide functional and technical knowledge for NCQA/HEDIS across all plan departmental staff and deliver educational sessions to internal staff and external constituents as needed.

• Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.

• Coordinate and implement interventions to increase HEDIS, CAHPS and designated health measures for the Health Plan.

• Support the coordination of corporate compliance and external surveys as needed.

• Monitor the creation of all project deliverables to ensure adherence to standards including design documents, test plans and operations documentation.

• Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure.

• Coordinate all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects with department staff and corporate contacts. Evaluate sources for alternative data capture; assess ongoing methodology and results.

• Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans.

• Approximately 10% travel.

Education/Experience:

• Bachelor’s degree in Healthcare, Business or equivalent experience. Master's in Public Health or related field preferred.

• 4+ years of quality improvement or project management experience in managed care with advanced knowledge of HEDIS and NCQA.

• Proficiency required in Microsoft applications including PowerPoint, Excel and Access.

• Experience and knowledge of medical coding, medical terminology highly preferred. Medical coding certification (i.e. – CPC, CSS) preferred.

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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