Quality Program Strategist II

This is a remote role. Schedule will align with EST hours. Experience with member engagement and improving member experience and CAHPS scores strongly preferred.

Position Purpose: Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities. Assists stakeholders to determine their business issues and recommend solutions to drive business value. Analyze stakeholder business issues, formulate hypotheses and test conclusions to determine appropriate solutions.

• 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.
• The assessment includes an end-to-end evaluation of the measure technical specification, performance trends, stakeholders, industry/research literature, organizational initiatives, associated policy and procedures, resources/tools.
• 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

Education/Experience: Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience. Master’s degree preferred. 4+ years of clinical experience, managed care or health insurance experience required; 2+ years of quality experience preferred.

License/Certification: Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW), preferred; CPHQ preferred

This is a remote role. Schedule will align with EST hours. Experience with member engagement and improving member experience and CAHPS scores strongly preferred.

Pay Range: $70,100.00 - $126,200.00 per year