Manager, Pharmacy Quality Analytics

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. Position Purpose: Manage and develop data necessary to analyze trends over various timeframes. Manage the data mining process and analysis using internally supported database programs. Collaborate with various departments and other key business units to identify areas for process improvement initiatives.

• Manage staff to ensure the accuracy and timeliness of data requests.
• Evaluate reports produced by the Quality Initiative (QI) Department and other various departments for trends and opportunities for improvement.
• Mange the design of tools and databases to capture and track data, methodologies, findings and analysis and ensure data collection/extractions, analysis and submissions meet regulatory compliance requirements.
• Monitor data/information to assist QI department staff members in improving NCQA/PQA and Department of Community Health (DCH) required measures.
• Research and establish benchmarks and statistics for quality measures.
• Develop, prepare and present reports on quality programs and issues to both internal and external stakeholders.
• Evaluate and test new or modified programs and procedures used to verify that QI functions and conforms to established guidelines.

Education/Experience:

• Bachelor’s degree in Business, Computer Science, Nursing, or other health care related field.
• 3+ years of related analytical experience in managed health care, Medicare or Medicaid.
• Experience with concepts of information management and an in depth knowledge of pharmacy/medical terminology, pharmacy claims processing, NDC/GPI/GCN, coding issues and practices, including ICD-9, CPT4, HCPCS Level II.
• Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
• Advanced Excel experience strongly preferred.
• SQL coding experience strongly preferred.
• Experience leveraging data from databases strongly preferred.

By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified. Pay Range: $86,000.00 - $154,700.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. 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 Apply tot his job Apply To this Job