Manager, Quality Improvement – HEDIS Audit

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🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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

• Oversee and manage the quality improvement program, specifically the state HEDIS audit and regulatory submission portfolio • Lead the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team • Support staff and communicate with departments and staff to facilitate daily quality improvement functions • Serve as a key escalation point for Health Plans, auditors, and internal partners • Oversee state HEDIS and regulatory reporting programs and state-specific audit requirements • Review and analyze reports, records, and directives • Confer with staff to obtain project data, work status, and encountered problems for planning activities • Verify submitted data for government program requirements and compliance with state, federal, and certification requirements • Prepare reports and records on work function activities for management • Oversee the review and analysis of reports • Evaluate and improve procedures and practices to accomplish work function objectives and ensure compliance with required standards • Collaborate with departments to document, investigate, and resolve complaints and appeals according to company and state policies and requirements • Monitor and analyze costs and participate in budget preparation

🎯 Requirements

• Bachelor’s degree in a related field or equivalent experience • 3+ years of clinical, quality management, or healthcare-related experience • 1 year of recent quality improvement and supervisory experience in a healthcare environment, preferably managed care • Strong knowledge of HEDIS, NCQA requirements, Medicaid quality reporting, and healthcare regulatory submissions strongly preferred • Experience leading complex audit or regulatory programs with multiple concurrent deadlines highly preferred • Certain states may require formal certification in quality improvement, risk management, or another parallel field • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future

🏖️ Benefits

• Competitive pay • Health insurance • 401K plans • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Accommodation support available