Quality Improvement Specialist Senior

Centene
Pennsylvania
Workplace: RemoteFull timeUSD 70,100 - 126,200 annuallyFunction: Quality & Regulatory (Non-Software)Skills: ["Communication","Cross-functional collaboration","Program leadership","Data-driven improvement"]

Coordinate regulatory, accreditation, clinical quality, and service improvement programs, leading multiple complex initiatives that improve health care delivery and member outcomes. Ensure programs meet accreditation, state, and federal requirements, assess performance and refine interventions, and manage vendor oversight. Drive measurable improvements in Star Ratings, HEDIS, and CAHPS, develop related communications and internal reporting, and present progress to senior leadership.

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FursaFursa
Centene
Centene
1 day ago

Quality Improvement Specialist Senior

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Last checked: 9 hours agoStatus: Live

Job Summary

Coordinate regulatory, accreditation, clinical quality, and service improvement programs, leading multiple complex initiatives that improve health care delivery and member outcomes. Ensure programs meet accreditation, state, and federal requirements, assess performance and refine interventions, and manage vendor oversight. Drive measurable improvements in Star Ratings, HEDIS, and CAHPS, develop related communications and internal reporting, and present progress to senior leadership.
Location: Pennsylvania
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Coordinate assigned regulatory, accreditation, clinical quality, and/or service improvement programs and act as a resource for training and interpretation.
  • •Lead and manage multiple complex quality or health services initiatives impacting care delivery for members.
  • •Ensure compliance of clinical and service quality improvement programs with accreditation and state/federal requirements.
  • •Assess program performance, refine interventions, and develop internal reports for senior-level staff.
  • •Develop targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction, and other performance measures; conduct vendor oversight and management.

Pay and Benefits

Salary: USD 70,100 - 126,200 annually
Perks:Health Insurance401kEquityLearning BudgetPaid LeaveRemote Work

Key Requirements

  • •Bachelor’s Degree or equivalent experience with a clinical license, or a Master’s degree in a related health field (e.g., MPH or MPA).
  • •Minimum three years of experience in a clinical/health care environment with the related degree program.
  • •Experience in compliance, accreditation, service, or quality improvement.
  • •Complex project management experience.
  • •Managed care experience (three to five years) and experience with Medicare and/or NCQA preferred.
Experience:Managed careMedicareNCQA
Education:
Skills:CommunicationCross-functional collaborationProgram leadershipData-driven improvement
Licenses:State clinical license
Certifications:CPHQ

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn