Director, Provider Quality

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.
 

We're seeking a Director of Provider Quality with experience engaging network providers, collaborating with health systems, and supporting provider contracting and incentive programs.

This is a remote role with a preference for candidates to reside in the state of Indiana.

Position Purpose:
Lead and direct process improvement activities that provide more efficient and streamlined workflow.

• Responsible for leading and collaborating 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
• For Coordinated Care – Washington – Director, Quality Improvement & Health Equity position only:
• Oversee Coordinated Care's Cultural Competency Program, including its Cultural Competency Plan focused on Culturally and Linguistically Appropriate Services (CLAS)
• Lead Coordinated Care’s Health Disparities efforts, including those focused on justice involved individual members
• Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities and reduce the cost of care.
• Work closely with State, County and local agencies, community stakeholders and communities to monitor the application of all standards
• Promote an environment of cultural competence throughout the health plan through identification and implementation of culturally-inclusive best practices and innovations, such as the development of provider trainings to improve cultural awareness and competency within the provider network
• Oversee the assessment of cultural diversity of the provider network to identify resources and gaps, including needs analysis for non-traditional providers (traditional healers, religious and spiritual resources, natural support systems, etc.) and develops recommendations for credentialing and network development activities.
• Monitor and evaluate provider practices through KPIs within health equity dashboards to assess and improve the cultural competence of delivered services by addressing care gaps and aligning interventions to resolve.
• Oversee the population specific activities (such as training, awareness through the media, and partnering with various external equity stakeholders), including cultural treatment teams and other cultural community support system activities.
• Oversee the comprehensive, outcomes-based Cultural Competency Plan that is aligned with CLAS standards and national and regional priorities/initiatives.
• The plan also incorporates data-driven assessments of culturally competent performance, and defines a strategy for the continual provision, monitoring and improvement of culturally competent performance.
• Manage outreach budget for Cultural Competency programs and sponsorships.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree Nursing, other related field or equivalent experience required
• Master's Degree preferred
• 7+ years of quality management, quality improvement or healthcare operations experience required
  
  
  Licenses/Certifications:
  
  Certified Professional in Health Care Quality preferred:

Pay Range: $113,100.00 - $209,100.00 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 ind