Manager, Performance Quality Improvement

About the role

The role provides strategic oversight of HEDIS Operations and Quality Improvement initiatives, driving excellence in NCQA and HEDIS performance across the organization.

Responsibilities

• Oversee and manage the functions of the quality improvement program from inception to closure, including NCQA and HEDIS performance improvement projects.
• Lead hybrid season planning and execution, ensuring audit readiness and regulatory reporting compliance.
• Oversee quality improvement related activities and staff to improve clinical quality performance measures.
• Analyze data to develop intervention strategies to improve outcomes.
• Develop and implement performance improvement projects.
• Develop, prepare, and present reports on quality programs and issues to both internal and external stakeholders.
• Provide data analysis and support for QM projects (i.e. outcome studies, QI projects).
• Coordinate ongoing data management for HEDIS and QI project management databases.
• Evaluate sources for alternative data capture, assess ongoing methodology and results.
• Develop, implement and monitor data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.
• Oversees the medical record management process for HEDIS reporting, including all processes involved with year-round abstraction and MRR.
• Oversee HEDIS team including workflow, tracking, reporting and improvement of processes related to member engagement and MRR efforts.
• Develops tracking, tools, and programs to support HEDIS staff to drive HEDIS and 5-Star project improvement activities.
• Ensures MRR efforts meet NCQA HEDIS audit standards.
• Performs other duties as assigned.

Requirements

Education/Experience: Bachelor's degree in healthcare, business, or related field or equivalent experience. 4+ years of quality improvement data and outcome analysis experience in health care. Experience in managed care with knowledge of HEDIS and NCQA preferred.

Preferred Experience

• Experience leading HEDIS Operations within a health plan, managed care, or healthcare quality environment.
• Strong knowledge of NCQA accreditation standards, HEDIS measures, hybrid methodology, and audit requirements.
• Demonstrated success managing hybrid reviews, chart retrieval operations, and vendor relationships.
• Experience with regulatory reporting, quality improvement programs, and performance measurement initiatives.
• Proven ability to lead large-scale operational projects and collaborate effectively across clinical, quality, analytics, and operations teams.

Skills

Preferred: Certified Professional in Healthcare Quality (CPHQ) preferred.

Benefits

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.

Pay

$87,700.00 - $157,800.00 per year