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VP, Quality Improvement

Centene Corporation Type Full time Posted 6/27/2014
Salary - n/a - Starts 7/24/2014
MA - Massachusetts (All) - Waltham Referral - n/a -    
Position Purpose: Oversee all related activities for the Quality Improvement and Credentialing functions. Lead and direct process improvement activities for more efficient and streamlined workflow.

Position Responsibilities:
  • Responsible for all activities related to National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
  • Ensure health plan is compliant and become or remain accredited with NCQA
  • Responsible for credentialing and re-credentialing of providers, including all physicians and mid-level practitioners, in accordance with Plan specifications and credentialing committee
  • Manage the credentialing process for all non-delegated practitioners and providers.
  • 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 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

      Knowledge/Experience: Bachelor's degree in Nursing or related clinical field. 10 years of healthcare operations experience, including quality improvement experience. Masters’ degree preferred.

      License/Certificates: Current state’s RN license. Certified Professional in Health Care Quality preferred.