Job Description
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.
**Position Purpose:** Develop programs and materials for specific provider networks to engage, recommend and support improved coding for direct impact on HEDIS data capture strategies in accordance with National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Set (HEDIS) standards and specifications. Provide insight and make recommendations to internal stakeholders on intervention opportunities.
* **_Note: Qualified candidates residing in California preferred._**
+ Develop programs and materials for improved data capture to close HEDIS data gaps.
+ 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.
+ 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 Health Plan.
+ 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.
+ Approximately 10% travel.
**Education/Experience:**
+ Bachelor's degree in Healthcare, Business or equivalent experience. Master's in Public Health or related field preferred.
+ 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.
+ _Experience and knowledge of medical coding, medical terminology highly preferred. Medical coding certification (i.e. - CPC, CSS) preferred._
Pay Range: $68,700.00 - $123,700.00 per year
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
Job Tags
Full time, Part time, Work at office, Remote work, Flexible hours,
Similar Jobs
ESRhealthcare
...RHEL Systems Engineer (11518-1) Boston, MA RedHat Linux, Red Hat Enterprise Linux 9, Shell Scripting, GPU If you post this... ...hourly payrate Total position: 1 Relocation assistance: No Visa sponsorship eligibility: No Job Description: We are seeking a skilled...
Get It - Marketing
Marketing Manager Location: Saint Louis, Missouri (Remote-Friendly) Who We're Looking For Are you a strategic marketing professional with a passion for digital marketing, lead generation, and content-driven campaigns? Do you thrive in a collaborative environment...
Beijing Linhai Zhongji Consulting Management Co., Ltd.
1. American-European citizenship or work experience in the United States;2. Have some of your own views and opinions on the political economy of the United States right now, including some of the hot social issues , macroeconomic trends , financial markets. 3. Provide...
Marriott
...experience.License or Certification: NoneThe pay range for this position is $37.55 to $38.30 per hour and offers health care benefits, retirement benefits, earned paid time off and/or sick leave, life insurance, disability coverage, and other life and work wellness benefits....
P & J CARRIERS INC
...CDL A Owner Operator PositionDry Van Why Us? ~10% under our authority ~ Affordable cargo insurance ~ Fuel Card Program -... ...rate of around $2.4 per mile Requirements Semi Truck with or w/out trailer Year 2008 and up Our Offer...