Vice President, Quality Improvement

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 Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review 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 Research and incorporate quality improvement best practices into operations Organize and control activities, methods, and procedures to achieve business objectives Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines Manage and ensure compliance of EPSDT program as well as compliance and turnaround time of grievances and appeals Education/Experience: Bachelor''s degree in Nursing or related clinical field or equivalent experience. Master''s'' degree preferred. 10+ years of healthcare operations experience, including quality improvement and NCQA accreditation experience. Experience managing acquisition and integration of external data sources. 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 License/Certification: RN license and Certified Professional in Health Care Quality preferred. For Carolina Complete Health plan: More than 5 years of demonstrated quality management/quality improvement experience in a large healthcare corporation serving Medicaid beneficiaries; NC licensed clinician (e.g. LCSW, RN, MD, DO);Certified Professional in Healthcare Quality (CPHQ) is preferred; must reside in NC. For Illinois plan only: Must reside in Illinois. Will be Illinois-licensed Physician, Illinois-licensed registered nurse, or another Illinois-licensed clinician. For Illinois plan only: Must reside in Illinois. Will be Illinois-licensed Physician, Illinois-licensed registered nurse, or another Illinois-licensed clinician. 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.

Created: 2025-10-04