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Quality Program Development Manager

Company: Wellcare New Jersey
Location: Prospect Park
Posted on: June 4, 2024

Job 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.
Important Note: Selected candidate must live in New Jersey, and will be required to travel within New Jersey on a regular basis. 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.
  • Prepares strategic analysis of potential business and/or operational opportunities in relation to new business, rebids, and QI targets using customized solutions.
  • 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.Candidate Education: 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:
    Preferred Six Sigma Certification
    Preferred Lean Certification

    New Jersey Health Plan only: Certified Professional in Healthcare Quality (CPHQ) or Healthcare Quality and Management (HCQM) required.Pay Range: $67,400.00 - $121,300.00 per yearCentene 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. Total compensation may also include additional forms of incentives.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.

Keywords: Wellcare New Jersey, Philadelphia , Quality Program Development Manager, Executive , Prospect Park, Pennsylvania

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