Manager, Performance Quality Improvement

Description

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 are seeking an experienced quality manager to provide strategic oversight of HEDIS Operations and Quality Improvement initiatives, driving excellence in NCQA and HEDIS performance across the organization. This role will lead hybrid season planning and execution, ensure audit readiness and regulatory reporting compliance, oversee vendor management and chart retrieval operations, and implement data-driven strategies to improve quality measure performance and health outcomes. The ideal candidate brings expertise in managed care quality programs, cross-functional leadership, and continuous process improvement to support organizational quality and regulatory goals.

Position Purpose: Oversee and manage the functions of the quality improvement program from inception to closure, including National Committee for Quality Assurance (NCQA) and Healthcare Effectiveness Data and Information Sets (HEDIS) performance improvement projects.

• 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.
• Complies with all policies and standards.

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.

License/Certificates: Certified Professional in Healthcare Quality (CPHQ) preferred.

Work Location: This position is fully remote, offering the flexibility to work from home. Occasional travel may be required, typically no more than 3–4 times per year, for team onsite meetings, training events, or corporate gatherings.

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. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act