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Centene Corporation

Quality Improvement Specialist Senior

Centene Corporation - Fresno, CA

ProfessionalThe Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical quality and/or service improvement programs. Functions as a leader for assigned health services initiatives handling multiple large-scale complex initiatives. Collaborates on national, regional and multi-plan initiatives. Develops programs in compliance with accreditation and regulatory requirements/ standards and monitors ongoing program performance to maintain compliance. Acts as a resource for training, policy and regulatory/accreditation interpretation.\u003Cbr\u003E\u003Cbr\u003ELeads and manages multiple complex initiatives that impact the quality or effectiveness of health care delivery and/or health care services provided to members.\u003Cbr\u003EEnsures that clinical and service quality improvement programs and initiatives are compliant with applicable accreditation, state and federal requirements.\u003Cbr\u003EConducts an assessment of programs, initiatives and interventions to ensure goals and objectives were met and refine activities, as needed, to improve the effectiveness and improve outcomes.\u003Cbr\u003EDevelops and submits regulatory reports at the time and in the manner required by state or federal agencies such as CMS.\u003Cbr\u003EConducts vendor oversight and management.\u003Cbr\u003EDevelops targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction and other identified performance measures.\u003Cbr\u003EDevelops and implements project-related communication including, but not limited to, member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas.\u003Cbr\u003EParticipates in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies and procedures, and improvement activities.\u003Cbr\u003EDevelops internal reports to demonstrate progress on each initiative/project and presents to senior-level staff. Describes outreach initiatives, potential/experienced barriers and activities to resolve issues and improve outcomes.\u003Cbr\u003ELeads and/or participates in multi-department/cross-functional committees and work groups which support key initiatives, prepares reports, data, agendas/minutes or other materials for committee presentation and management.\u003Cbr\u003EIdentifies areas of improvement within the company and works collaboratively with other departments to develop clinical and non-clinical performance improvement projects.\u003Cbr\u003EResearches best practices, national and regional benchmarks, and industry standards. \u003Cbr\u003EDevelops collaborative relationships with contracted providers or provider groups to promote participation in quality improvement collaboratives to improve clinical care outcomes.\u003Cbr\u003ERepresents Health Net at external work groups and committees. May lead and/or participate in external activities, work groups or committees when applicable.\u003Cbr\u003ECommunicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures.\u003Cbr\u003EIn conjunction with Medical Director, communicates quality improvement initiatives, results, and/or performance data to participating physician groups.\u003Cbr\u003EDevelops and/or maintains relationships with other external organizations to expand key partnerships.\u003Cbr\u003EAssesses current industry trends and regulations for enterprise-wide adoption to assure quality and effectiveness of health care delivery and/or healthcare services provided to members.\u003Cbr\u003EPerforms all other duties as assigned.\u003Cimg src=\;sz=1x1;ord=0123456789;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=?\ border=\0\ width=\1\ height=\1\ alt=\Advertisement\\u003E,datePosted:2018-05-06,employmentType:FULL_TIME,industry:Manufacturing/Production,hiringOrganization:{@type:Organization,name:Centene},identifier:{@type:PropertyValue,name:Centene,value:1097700},jobLocation:{@type:Place,address:{@type:PostalAddress,addressCountry:US,streetAddress:,addressLocality:Fresno,addressRegion:CA,postalCode:93701}}}

16 days 22 hours ago

Centene Corporation


Quality Improvement Specialist Senior Centene Corporation - Fresno, CA, United States


Location: Fresno, CA

Company Profile:
Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations