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Director, Quality Improvement
Centene Corporation. Lead and direct process improvement activities that provide more efficient and streamlined workflow .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in quality management and improvement within healthcare operations, with a strong focus on NCQA Accreditation, HEDIS performance, and cultural competency. Proven ability to lead teams, implement best practices, and enhance provider satisfaction through data-driven strategies.
Highest-signal resume keywords
Quality ManagementNCQA AccreditationHEDIS PerformanceCultural CompetencyHealthcare Operations
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality ImprovementRisk ManagementData-Driven AssessmentsProvider Network AssessmentHealth Equity Monitoring
Soft Skills
LeadershipCollaborationCommunicationOrganizational Skills
Tools & Technologies
Health Equity DashboardsKPI Monitoring Tools
Certifications & Qualifications
Certified Professional in Health Care QualityRN License
Industry Keywords
Medicare STARSCLAS StandardsCultural CompetenceHealth DisparitiesProvider Satisfaction Surveys
About the role
Key responsibilities & impact- Lead and direct process improvement activities that provide more efficient and streamlined workflow
- Lead and collaborate with others on NCQA Accreditation and/or HEDIS performance
- Lead quality improvement aspects of risk adjustment processes for all products
- Collaborate with the Medicare STARS team to improve STARS ratings for Medicare products
- Oversee provider satisfaction surveys and implement improvement action plans
- 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 foster team concepts with internal and external constituencies
- Present improvement results and ongoing performance measures to senior management
- Formulate and establish policies, operating procedures, and goals in compliance with guidelines
- Collaborate with State, County, and local agencies to promote services that improve health outcomes, decrease health disparities, and reduce cost of care
- Monitor application of standards with agencies, community stakeholders, and communities
- Promote cultural competence throughout the health plan through culturally inclusive best practices and provider training
- Oversee assessment of provider-network cultural diversity, identify resources and gaps, and develop credentialing and network-development recommendations
- Monitor and evaluate provider practices through KPIs and health equity dashboards
- Oversee population-specific activities, cultural treatment teams, and community support systems
- Oversee the outcomes-based Cultural Competency Plan aligned with CLAS standards and national and regional priorities
- Incorporate data-driven assessments and strategies for continual monitoring and improvement of culturally competent performance
- Manage outreach budget for Cultural Competency programs and sponsorships
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Must reside in Indiana or be willing to relocate to Indiana
- Bachelor's Degree Nursing, other related field or equivalent experience required
- 7+ years of quality management, quality improvement or healthcare operations experience required
- Certain states may require a formal certification in quality improvement, risk management, or another parallel field
- Current state’s RN license preferred
- Certified Professional in Health Care Quality preferred
- Master's Degree preferred
- Ability to lead and collaborate on NCQA Accreditation and/or HEDIS performance
- Knowledge of Medicare STARS, including HEDIS, CAHPS, and HOS
- Knowledge of cultural competency, CLAS standards, health equity, and provider network assessment
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity