Manager, Quality Improvement – HEDIS Audit

🕒 August 17

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 23%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 functions • Lead the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team • Provide support to staff and communicate with departments and staff to facilitate daily quality improvement functions • Serve as 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, work status, and problem data for planning work function activities • Verify submitted data in accordance with government program requirements and ensure 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 current procedures and practices and develop and implement improved procedures and practices • Collaborate with departments to document, investigate and resolve complaints and appeals according to Company and State policies, procedures and requirements • Monitor and analyze costs and participate in budget preparation

🎯 Requirements

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

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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 • Equal opportunity employer committed to diversity