Quality Program Development Manager

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. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.To be considered for this Quality Program Development Manager role, candidates will bring a bachelor’s degree (or equivalent experience) and 5+ years of healthcare program or project management experience, including 3+ years in managed care. Candidates should also have at least 2+ years of experience designing and implementing quality programs (e.g., HEDIS, CAHPS, STARS) and working across cross-functional healthcare environments.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.This role will support regulatory and quality improvement initiatives, including coordination of NCQA, PIP, and state compliance deliverables across Medicaid and Medicare lines of business. Responsibilities include leading cross-functional efforts to manage complex deliverables, maintain audit readiness, and drive data-informed performance improvement. Experience in healthcare regulatory, accreditation, or quality improvement environments preferred.In this Quality Program Development Manager role, you will:Own regulatory and accreditation deliverables (NCQA, PIPs, state requirements), ensuring on-time submission and sustained audit readinessDrive audit readiness by establishing and maintaining scalable documentation, workflows, and submission processes that support compliance and reduce riskLeverage performance data to identify gaps, lead root cause analysis, and drive targeted quality improvement initiatives that enhance outcomesOversees 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 necessaryPartners 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 careConducts other responsibilities as needed.Performs other duties as assignedComplies with all policies and standardsWhat’s appealing about this role:Meaningful, visible impact - Directly influences quality outcomes, regulatory performance, and member experience through high-impact initiatives (NCQA, PIPs, and compliance deliverables)Cross-functional leadership exposure - Partner with leaders across Quality, Clinical, Operations, and Analytics to drive enterprise initiatives and strategic decisionsGrowth in a specialized, in-demand area - Build expertise in regulatory compliance, accreditation, and data-driven performance improvement while leading complex, high-priority workEducation/Experience: Required: A Bachelor's Degree in a related field, or equivalent work experience in Business, HC Management, or NursingPreferred: A Master's Degree in a related field: Business or HC Management (MBA, MHA, MPH, MSN)Required experience:5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH2+ 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 financingIntegration of behavioral, clinical, social, and community health care for members with multiple chronic conditionsWorking with multiple market leaders to coordinate consistent quality initiativesConducting 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 wideLicenses and Certifications: A license in one of the following is preferred:Preferred Six Sigma CertificationPreferred Lean Certification: Preferred Certified Professional in Healthcare Quality (CPHQ)Highly preferred:Expertise in regulatory compliance and accreditation (NCQA, PIPs, Medicaid/Medicare)Experience leading cross-functional