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Senior Quality Improvement Specialist
Centene Corporation. Coordinate assigned regulatory, accreditation, clinical quality and/or service improvement programs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in coordinating regulatory and accreditation programs while leading complex health services initiatives. Proficient in developing action plans and monitoring performance measures to enhance quality improvement and compliance with industry standards.
Highest-signal resume keywords
Regulatory ComplianceQuality Improvement ProgramsProject ManagementMedicaid ProgramsClinical Quality Assessment
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Action Plan DevelopmentPerformance MeasurementData ReportingVendor ManagementClinical Quality Improvement
Soft Skills
CollaborationCommunicationRelationship BuildingProblem Solving
Tools & Technologies
HEDISCAHPSStar RatingsIVR Systems
Certifications & Qualifications
Certified Professional in Health Care Quality (CPHQ)Valid State Clinical License
Industry Keywords
Managed CareAccreditation StandardsFederal RequirementsState RegulationsHealth Care Environment
About the role
Key responsibilities & impact- Coordinate assigned regulatory, accreditation, clinical quality and/or service improvement programs
- Lead multiple large-scale complex health services initiatives and collaborate on national, regional and multi-plan initiatives
- Lead Medicaid state withhold and pay-for-performance programs
- Develop and monitor measure-level action plans, interventions, reporting, and financial impact
- Ensure quality improvement programs comply with accreditation, state and federal requirements
- Assess programs, initiatives and interventions and refine activities to improve effectiveness and outcomes
- Conduct vendor oversight and management
- Develop targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other performance measures
- Develop project communications, including mailings, IVR scripts, emails, business plans, graphics, agendas and minutes
- Maintain quality improvement program documents and evaluations, compliance audits, policies, procedures and improvement activities
- Develop internal progress reports and present to senior-level staff
- Lead or participate in cross-functional committees and work groups
- Identify improvement opportunities and develop clinical and non-clinical performance improvement projects
- Research best practices, benchmarks and industry standards
- Build relationships with providers and provider groups to promote quality improvement collaboratives
- Communicate programs, interventions and results to external entities
- Maintain external partnerships and assess industry trends and regulations for enterprise-wide adoption
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Bachelor’s Degree or equivalent experience with clinical license, or Master’s Degree in related health field (i.e. MPH or MPA)
- Valid state clinical license preferred
- Certified Professional in Health Care Quality (CPHQ) preferred
- Minimum three years experience in a clinical/health care environment with related degree program
- Three to five years managed care experience in a health care environment
- Experience in compliance, accreditation, service or quality improvement
- Complex project management experience
- Experience with Medicare and/or NCQA preferred
- Knowledge of accreditation, regulatory, state and federal requirements
- Ability to interpret contractual requirements and performance targets
- Experience developing and monitoring action plans, interventions, reporting, and financial impact
Benefits
Comp & perks- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
- additional forms of incentives may be included in total compensation