Note: The job is a remote job and is open to candidates in USA. WellCare of Kentucky is part of Centene, a national organization focused on transforming community health. The Quality Program Development Manager will collaborate with various departments to develop and implement standards and procedures aimed at improving clinical and administrative operations while ensuring compliance with regulatory and quality improvement initiatives.
Responsibilities
- Own regulatory and accreditation deliverables (NCQA, PIPs, state requirements), ensuring on-time submission and sustained audit readiness
- Drive audit readiness by establishing and maintaining scalable documentation, workflows, and submission processes that support compliance and reduce risk
- Leverage performance data to identify gaps, lead root cause analysis, and drive targeted quality improvement initiatives that enhance outcomes
- 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
- Performs other duties as assigned
- Complies with all policies and standards
Skills
- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- A bachelor's degree (or equivalent experience)
- 5+ years of healthcare program or project management experience
- 3+ years in managed care
- At least 2+ years of experience designing and implementing quality programs (e.g., HEDIS, CAHPS, STARS)
- Experience in healthcare regulatory, accreditation, or quality improvement environments
- 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment
- 3+ years of experience in managed care, plus utilization management, care coordination, disease management, Medicare, Medicaid, DSNP, dual eligibles, PCMH
- 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
- A Bachelor's Degree in a related field, or equivalent work experience in Business, HC Management, or Nursing
- A Master's Degree in a related field: Business or HC Management (MBA, MHA, MPH, MSN)
- Six Sigma Certification
- Lean Certification
- Certified Professional in Healthcare Quality (CPHQ)
- Expertise in regulatory compliance and accreditation (NCQA, PIPs, Medicaid/Medicare)
- Experience leading cross-functional initiatives in fast-paced, deadline-driven environments
- Ability to analyze healthcare performance data and drive targeted quality improvements
- Strong skills in audit-ready documentation, reporting, and process improvement
- Background in managed care, quality, or program development (3–5+ years)
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- 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, including full-time or part-time status
- Total compensation may also include additional forms of incentives
- Benefits may be subject to program eligibility
Company Overview
WellCare of Kentucky is the Medicare brand that takes the nonsense out of health insurance. It was founded in 1985, and is headquartered in La Grange, Kentucky, USA, with a workforce of 201-500 employees. Its website is https://www.wellcare.com/kentucky.