Director, Quality Improvement, Digital Quality Measurement

About the role

Lead and direct process improvement activities that provide more efficient and streamlined workflow. This leadership role will shape and execute the organization’s digital quality measurement strategy, helping modernize how clinical quality data is collected, validated, and reported. At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Responsibilities

• Lead and collaborate with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
• Responsible for quality improvement aspects of risk adjustment processes for all products
• Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS)
• Oversee provider satisfaction surveys and implement action plans for improvements
• Research and incorporate best practices into operations
• Organize and control activities, methods, and procedures to achieve business objectives
• Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
• Present results of improvement efforts and ongoing performance measures to senior management
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
• Lead the strategy, roadmap, testing, validation, and audit readiness for digital quality measurement, HEDIS, and related clinical quality initiatives

Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future (no sponsorship available for H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT)
• Applicants have the flexibility to work remote from home anywhere in the United States
• Bachelor's Degree in Nursing, other related field or equivalent experience required
• Master's Degree preferred
• 7+ years of quality management, quality improvement or healthcare operations experience required
• Current state’s RN license preferred
• Certified Professional in Health Care Quality preferred
• Certain states may require a formal certification in quality improvement, risk management, or another parallel field

Skills

• Experience with digital quality measurement, HEDIS, ECDS, FHIR, healthcare interoperability, or related quality transformation initiatives (highly preferred)
• Strategic thinking
• Knowledge of audit readiness
• Ability to translate clinical requirements into operational and technology solutions

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

Pay

Pay Range: $107,700.00 - $199,300.00 per year. 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.