Director, Quality & Process Improvement, HEDIS Audit

🕒 June 2

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Lead and direct process improvement initiatives by utilizing process improvement methodologies in the analysis of current operations and design of improvement projects across all areas that impact operations • Support NCQA HEDIS audit readiness and compliance, ensuring accurate and timely submissions • Lead daily audit readiness activities, including Roadmaps, Section 5 documentation, Measure Specifications, CAHPS coordination, and auditor engagement • Oversee the administration, coordination and evaluation of quality assurance and training • Direct the execution of performance improvement projects, including process mapping and process design including HEDIS audit timelines and deliverables • Serve as primary point of contact for auditors and leadership, supporting audit communications and successful outcomes • Create and maintain dashboards, communications, and strategies to improve effectiveness • Research and develop best practices, policies, procedures, and goals in compliance with internal and external guidelines • Oversee data analysis and gathering processes and programs to establish costs and benefits of process effectiveness and efficiency • Ensure business unit is compliant with URAC and Joint Commission Accreditation standards • Review and implement new technological tools and processes • Establish strong collaborative relationships with all functional units and their leaders

🎯 Requirements

• Bachelors Degree in related field • 6+ years of quality and process improvement experience • Healthcare industry experience preferred • Knowledge of research methodologies including measures and outcomes • knowledge of process mapping, process design, and workflow management software and applications • URAC and Joint Commission Accreditation experience preferred • Experience with NCQA HEDIS measures or audit processes highly preferred

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules