Note: The job is a remote job and is open to candidates in USA. Centene Corporation is a diversified, national healthcare organization focused on transforming the health of its 28 million members. The Quality Improvement Project Manager coordinates quality improvement and organizational projects, including NCQA and HEDIS preparation, manages data review and project documentation, and supports interventions, audits, compliance, and accreditation activities.
Responsibilities
- 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
- Coordinate Work Plan, team and resources for HEDIS/Consumer Assessment of Healthcare Providers and Systems (CAHPS) submission to Connector Authority and NCQA
- Analyze data and develop presentations and materials for committee and articles for newsletters and other educational pieces
- 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 Plan
- Adhere to NCQA standards and work with Corporate Director of Accreditation in maintaining Plan’s NCQA accreditation
- 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
Skills
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- Qualified candidates must reside in the state of Florida
- Bachelor's degree in Healthcare, Business or equivalent experience
- 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
- Registered Nurse (RN), Licensed Practical Nurse, Licensed Clinical Social Worker (LCSW) or CPHQ certification highly preferred
- Master's in Public Health or related field preferred
Benefits
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
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