Program Manager II

Note: This is a fully remote role. 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: Lead the Corrective Action Plan (CAP) program for underperforming provider groups, driving measurable improvement in Medicare Stars, preventive care, and other quality measures. This role oversees program strategy, performance monitoring, governance, and cross-functional execution to strengthen accountability and support organizational quality objectives.

• Manage CAP initiatives through the full program life cycle, including plans, timelines, milestones, resources, risks, and deliverables.

• Analyze scorecards, dashboards, and performance trends to identify gaps, root causes, risks, and improvement opportunities.

• Partner with Provider Engagement, Quality, Clinical, Network Operations, Analytics, and provider groups to implement corrective actions and remove barriers.

• Lead workgroups and governance meetings; track decisions, action items, escalations, and accountability.

• Prepare executive reporting and communicate program status, outcomes, risks, and recommendations to stakeholders.

• Standardize processes, documentation, and reporting tools while identifying and scaling effective performance-improvement practices.

• Support business department initiatives that promote, quality, safety and cost of care opportunity.

• Responsible for gathering requirements, creating plans and schedules, managing resources, and facilitate project execution and deployment.

• Utilize corporate and industry standard tools and techniques to effectively oversee programs according to department procedures.

• Maintain detailed business process documentation including meeting minutes, action items, issues lists and risk management plans as applicable.

• Create and monitor all department deliverables to ensure adherence to quality standards including clinical reporting documents, related reference materials, and policy and procedure documentation.

• Communicate program status to management and key stakeholders.

• Identify resources, resolve issues, and mitigate risks.

• Identify requirements, procedures and problems to improve existing processes

• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and business objectives

• Manage projects through the full project life cycle

• Provide leadership and effectively communicate project status to all stakeholders

• Negotiate with project stakeholders to identify and secure resources, resolve issues and mitigate risks
• Performs other duties as assigned.

• Complies with all policies and standards.

Education/Experience: Bachelor’s degree in a related field or equivalent experience required. Three or more years of program management, project management, quality improvement, or healthcare operations experience required. Experience leading complex cross-functional initiatives and using data to drive measurable results required. Healthcare quality, provider engagement, value-based care, HEDIS, Medicare Stars, risk adjustment, or population health experience preferred. Strong executive communication, stakeholder management, analytical, and problem-solving skills required.

For DE only:
Position Purpose: Coordinate with teams to ensure HEDIS data accuracy and reporting, including investigations, auditing, and improvement opportunities. Collaborate with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members.
3 years of experience in QI, HEDIS PM or health care related experience. Working knowledge of NCQA and HEDIS programs.

For Carolina Complete Health:
In addition to the above experience:

• Minimum 2 years’ working/service Medicaid beneficiaries
• Minimum 2 years’ project management experience coordinating large complex engagements
• Minimum 2 years’ experience coordinating varied stakeholders
• Minimum 2 years in an organization or field that demonstrates an understanding of impact of social needs on individuals’ health and well-being

For Virginia Total Care (VTC) only:
Position Purpose: Oversee the delivery of VTC’s Consumer Directed (CD) services and collaborate with DMAS, F/EAs, Service
Facilitators, VBP partners and other CCMC health plans to develop system-wide solutions and quality CD services.

In addition to the experience requirements listed above: min 2 years of experience working directly in CD services or 3 years of experience with wavier programs and working knowledge of CD services; preferably in a Managed Care environment.

For New Hampshire Healthy Families only: 4 years’ experience with transportation. Position purpose: Helping to identify, secure, and maintain transportation for Members, including overseeing the MCO’s NEMT Subcontractor, proactive identification and proposal of
operational improvements in the program, resolution of issues requiring immediate attention, including Member
and transportation providers complaints, and real-time assistance with rescheduling service.

For Sunshine Health Quality Improvement: Bachelor’s degree in Public Health, Health Sciences, Healthcare Administration, related field or equivalent experience. Bachelor's degree preferred. 3+ years of program management, project management or healthcare experience.

Pay Range: $70,100.00 - $126,200.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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