Operations Quality & Affordability (QAI) Director

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:

The Operations QAI Director will support the goals and outcomes of the Enterprise Operations – Strategic Initiatives organization by leading initiatives and projects to aimed at meaningfully and measurably improving healthcare quality & affordability at speed.  The primary focus of this small, distinctive team is driving claims accuracy and contributing to affordability by identifying and delivering health care cost improvements through operational levers, including but not limited to Third Party Liability (TPL) identification and Coordination of Benefits (COB).  The successful candidate will have a demonstrable track record of building and operating large scale Medicaid TPL/COB solutions at a Health Care Payer or Health Care Services organization.  The team will continuously identify and lead initiatives to drive and sustain value that ultimately benefit Centene’s members and clients.  The team will also lead a small number of other highly strategic projects outside the scope of QAI, which could be related to stakeholder experience, operating costs, or other measures of value.  

The Operations QAI Director will work extensively across organizational lines to engage and influence individuals from Operations, Technology, Markets, Lines of Business, and Payment Integrity to execute with urgency while also looking multiple years ahead to influence continued progression and sustainability.  The individual may have accountability for leading several initiatives from a dynamic QAI portfolio at any given time and will utilize and further develop a wide variety of skills and behaviors including leadership, strategy, process design, business case management, change management, and project management.  At least half of the Director’s time will focus on advancing Centene’s TPL capability across Medicaid, Marketplace, and Medicare; with the in-place TPL Strategy Owner reporting to this leader. 

The Operations QAI Director will work with direct reports and hand-in-hand with other Strategic Initiatives team members to collaborate in a matrix fashion across a broad portfolio of initiatives.  The team has high executive visibility and impact.  Over time, there will be opportunities for high performers to advance within the team and opportunities to advance into other leadership positions across Centene. 

• Provide oversight for team of Business Process Consultants to lead and support the business case development for proposed initiatives, drive and support strategic planning processes, and collaborate with key stakeholders to lead/execute on larger scale, cross-functional initiatives.

• Ensure proposed business valuation maximizes impact with an emphasis on hard dollar Return on Investment (ROI) savings or cost avoidance scenarios.

• Set strategy for business process/transformation team. Demonstrate and execute thought leadership through out of the box thinking based on extensive industry knowledge, research and experience.

• Provide oversight and direction for team to lead large scale, cross-functional initiatives that are intended to drive significant performance improvement, financial gains, provider/member satisfaction and improved compliance through strategic partnerships.

• Ensure business case development (with documentation and clear responsibilities for stakeholders) for proposed initiatives to ensure adequate assessment of feasibility, opportunities, risks and return on investment to meet key business objectives.

• Lead and drive large scale workshops including all levels and stakeholders through strategic, organization design, technology prioritization decisions, root cause analysis, and process mapping.

• Provide input and support for planning and prioritization of initiatives as part of the strategic roadmap and business planning process meet key business objectives.

• Provide strategic and policy guidance on assigned initiatives so that all processes are considered for maximizing effective implementation and results. Perform detailed analysis of data, workflows, policies, procedures, organization of staff, and skills to execute initiatives.

• Drive consensus and ensure end to end policy/process integrity to accomplish project work up to and including final recommendations and implementation.

• Collaborate to ensure that timely communication to all levels of the organization to ensure support, awareness and effectiveness of process improvement initiatives is delivered.

• Perform other duties as assigned.

• Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in a related field required
8+ years experience managing large scale projects in at least 3 of the following areas: process improvement/transformation, business/financial analysis, external consulting/auditing/risk analysis, customer journey/experience, organizational change management, IT solution/architecture, project management required
5+ years in the health care industry required

Demonstrated willingness and ability to influence others towards a common goal without organizational authority

5+ years experience in leading Health Care affordability initiatives, e.g. Payment Integrity preferred

3+ years experience building and operating large scale Medicaid TPL/COB solutions at a Health Care Payer or Health Care Services organization preferred

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act