Quality Program Strategist II

Quality Program Strategist II

Requirements

• Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience
• 4+ years of clinical experience, managed care or health insurance experience required
• Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW), preferred

Responsibilities

• Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities
• Conduct evaluations to assist with HEDIS gap closure, CAHPS and/or HOS performance and assess for potential pilot programs and/or process improvements to achieve sustainable quality performance goals
• Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements
• Collaborate and provide support to markets & key business stakeholders to drive continued measure performance
• Develop HEDIS, CAHPS, and/or HOS support resources and tools to foster gap closure & improve experience for members and providers
• Conduct ongoing assessment to determine health plan needs, collaborating with cross-functional teams to ensure successful end to end execution of strategic initiatives
• Monitor and ensure compliance related to state reporting, HHS and HPMS memos for quality ratings
• Establish quality check policy/procedures for all member and provider communications to ensure accuracy of information, data, and alignment with Centene business goals
• Establish QPS policies, procedures, and quality checks for all reoccurring departmental programs/activities, to ensure precision execution and accuracy
• Create, maintain and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibility
• Performs other duties as assigned
• Complies with all policies and standards

Preferred Qualifications

• Master’s degree preferred
• 2+ years of quality experience preferred
• CPHQ preferred