Remote HEDIS Specialist, MO


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Business Area: Quality
Job Type: Full time
Job Number: 1486163


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.

Position Purpose: Supervise and facilitate successful interventions to meet behavioral health HEDIS and Pay for Performance measures. Partner with health plans and regional clinical leadership to identify and implement interventions to increase HEDIS rates in behavioral health measures.

  • Develop and implement innovative strategies in collaboration with clinical staff to improve compliance with key behavioral health HEDIS metrics and Pay for Performance (P4P) Measures
  • Prepare and present financial impact and return on investment on initiatives requiring additional funding or resources
  • Act as a liasion with quality improvement, health plan medical management and other departments regarding current and planned interventions, collect input on how to impact these outcomes, and provide feedback to stakeholders on outcomes
  • Monitor the effectiveness for new and existing P4P and HEDIS initiatives and ensure appropriate knowledge/education and interventions are conducted for members falling into these measures
  • Analyze data to address trends or potential quality and clinical improvement opportunities based on best practices and feedback from involved stakeholders

Education/Experience: Bachelor’s degree in nursing, related field, or equivalent experience. 3+ years of experience in case and/or utilization management in a behavioral health or physical health care setting. Knowledge of key behavioral or physical health related HEDIS & performance measures required with preferred experience in implementing new interventions to affect these rates. Supervisory or lead experience preferred

License/Certificates: Current state’s unrestricted license as a LCSW, LMFT, LPC, PhD, PsyD or RN preferred

For Health Net Federal Services only: Government Security/Clearance/US Citizenship RequirementsPay Range: $52,900.00 – $95,200.00 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. 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.