You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
REMOTE Position manages Pharmacy Quality Improvement Programs
Open to ALL states but must work Monday - Friday: 8 am - 5 pm (CST)
Position Purpose: Oversee and manage the functions of the quality improvement program, including HEDIS reporting and other quality improvement activities. Providing support to staff and communicate with departments and staff to facilitate daily quality improvement (QI) functions
- Review and analyze reports, records and directives.
- Confer with staff to obtain data such as new projects, status of work in progress, and problems encountered, required for planning work function activities, including HEDIS reporting.
- Verify data to be submitted in accordance with government program requirements and ensure compliance with state, federal and certification requirements.
- Prepare reports and records on work function activities for management.
- Oversee the review and analysis of reports.
- Evaluate current procedures and practices for accomplishing the assigned work functions objectives to develop and implement improved procedures and practices and to ensure compliance with required standards
- Manage delegate vendor oversight and corrective action plans as indicated.
- Monitor and analyze costs and participate in the preparation of the budget.
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Bachelor’s degree in health-related field or equivalent experience. 4+ years of quality improvement is required. Supervisory experience in a healthcare environment preferred. Clinical background preferred.
License/Certification: Certified Professional in Healthcare or quality improvement certification preferred.
Preferred Experience:
- Extensive Quality Assurance experience within Healthcare Operations, Pharmacy, Managed Care Quality Measures - NCQA/HEDIS measures, CMS STAR, and/or Medicare STAR Ratings, QA administration that focuses on closing health care gaps for patients
- Process Improvement or Project Management experience in Quality Healthcare operations
- Quality Improvement experience, knowledge, and skills in an Advisory/Consultative role
- Experience training and educating physicians and clinical staff on Pharmacy Quality initiatives
- Data Analysis skills – interpreting statistical data, assessing performance, and making recommendation in areas of pharmacy quality improvement
- Advanced Excel skills – be able to create or abstract data from an Excel Workbook
- Strategic Advisor/Consultative skills, Emotional Intelligence, Communication/Public Speaking, Coaching/Training, Time Management, and Organizational skills are critical in this role
- Experience and working knowledge with Medicare, Medicaid and Marketplace insurance practices and regulations is preferred
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
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