You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Supervise and coordinate team ensure HEDIS data accuracy and reporting, including investigations, auditing, and improvement opportunities. Collaborate with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members.
- Coordinate activities, resources, methods, and procedures to achieve improvement in HEDIS measures with the business leaders and cross functional departments
- Coordinate with the department leader to formulate and ensure compliance with HEDIS technical specifications, policies, operating procedures, and goals in compliance with internal and external guidelines
- Supervise the daily activities of staff to promote quality improvement and efficient methods
- Assist with comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures
- Coordinate clinical quality metrics and HEDIS processes and results
- Coordinate cross functional process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
- Manager the coordinate HEDIS projects to include assignment of nurses, adherence to plan timelines, and vendor oversight for timeliness and quality
- Ensure compliance for all quality audits and maintain all data and process controls
Education/Experience: Bachelor's degree in Business Administration or Health Care Administration or equivalent experience. 3+ years of quality improvement, HEDIS project management or health care related experience. Working knowledge of NCQA and HEDIS programs.Pay Range: $67,400.00 - $121,300.00 per year
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. Total compensation may also include additional forms of incentives.
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
