Position Purpose:
Functions as a program development manager in collaboration with Quality, Health Services and Operations business owners or cross-functional work groups in the development and implementation of efficient and effective standards, policy and procedures, work flows, and decision support systems to support ongoing improvements of clinical and administrative operations.

• Oversees the creation and implementation of programs relevant to the organization's strategic initiatives involving Health Services, clinical and operational quality administration.
• Designs and facilitates the development of various programs/systems, work flows, and integration efforts in alignment with Corporate, market, contractual, regulatory and quality requirements.
• Acts as the content and technical subject matter expert to the operation managers and directors for key project initiatives including the development of detailed work plans, facilitating route cause analysis, identifying and socializing process enhancements, setting deadlines, assigning responsibilities, and monitoring/summarizing project progress.
• Leads state required Performance Improvement Projects (PIP) including topic selection, root cause analysis, implementation, and final submission.
• Conducts needs assessments and identification to ensure the program teams and other external stakeholders receive information in a timely manner.
• Partners with leaders and members of the Quality Analytics and Improvement Teams and determines data needs as well as assists in designing tools and reports as necessary
• Partners with clinical and operations staff with consulting and analysis services to support initiatives intended to achieve breakthrough or incremental process improvement in patient quality of care
• Conducts other responsibilities as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:
Required A Bachelor's Degree in a related field

Required or equivalent work experience Business, HC Management, or Nursing:
Preferred A Master's Degree in a related field Business or HC Management (MBA, MHA, MPH, MSN):
Candidate Experience: Required 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment
Required 3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH

Required 2+ years of experience in design, develop and implement STARS, CAHPS, HEDIS and other enterprise quality related programs across a variety of settings including: defining the eligible population, service mix, delivery system configuration and financing; integration of behavioral, clinical, social, and community health care for members with multiple chronic conditions; working with multiple market leaders to coordinate consistent quality initiatives; conducting assessments, contractual reviews, and business plans for new quality improvement, including internally sourced or vendor sourced quality programs, and/or the integration of innovative approaches to defined programs to improve quality ratings company wide.

Licenses and Certifications : A license in one of the following is preferred
Six Sigma Certification
Lean Certification

Certified Professional in Healthcare Quality (CPHQ)


 

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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