Job Description

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

Must reside in Iowa, Missouri, Kansas, Nebraska. Relocation assistance available

Position Purpose:

Oversee all related activities for the Quality Improvement functions. Lead and direct process improvement activities for more efficient and streamlined workflow. Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans.

Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance ensuring highest level of accreditation and health plan rating. Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review. Responsible for insuring no loss of revenue due quality performance related to state contracts either through Pay for Quality program or liquidated damages due not hitting dashboard measures. Responsible for managing member engagement vendor including the setting of performance standards and monitoring of performance standards. Review and implement new technological tools and processes and foster team concept with internal and external constituencies. Present results of improvement efforts and ongoing performance measures and recommend actions plans to senior management. Manage and ensure compliance of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program as well as compliance and turnaround time of quality of care reviews. Responsible for all activities related to risk adjustment performance ensuring highest level of return. Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines. Responsible for all activities related to Risk Adjustment performance including outreach and chart review to ensure highest level of return. Participate in, attend and plan/coordinate staff, departmental, committee, sub-committee, community, State and other activities, meetings and seminars. Work collaboratively with Provider Performance to support the expansion of alternative payment models using HEDIS data. Performs other duties as assigned. Complies with all policies and standards.

Education/Experience:

Master's Degree in Nursing or related clinical field or equivalent experience required.

10+ years of experience managing acquisition and integration of external data sources required.

Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

Familiarity with running risk adjustment prospective and retrospective programs preferred.

RN license and Certified Professional in Health Care Quality preferred.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.


Pay Range: $213,300.00 - $403,700.00 per year
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