Case Auditor

Centene Corp.; Northern (KY); Hybrid; USD 28,000 - 48,000; Full time

Job summary

Centene Corp. seeks a Case Auditor to ensure accuracy and compliance in care management. This remote role requires residence in Oklahoma and focuses on NCQA/HEDIS audits, documentation reviews, and regulatory alignment.

You will develop audit tools, generate reports, and collaborate with leadership to address findings and drive quality improvements while maintaining strong stakeholder communication.

Qualifications

• High School diploma or GED is required.
• 2-4 years of related experience.
• Experience with NCQA, HEDIS, and healthcare regulatory requirements.

Responsibilities

• Audit care management records, documentation, and workflows for compliance with internal policies and NCQA/regulatory standards.
• Identify trends, discrepancies, or risks and provide actionable recommendations to leadership.
• Develop and maintain audit tools, scorecards, and tracking systems for objective reviews.
• Collaborate with care management leadership to address audit findings and implement corrective actions.
• Prepare audit reports, track performance metrics, and present findings with clear insights to management.

Skills

Auditing

Case management

NCQA

HEDIS

Healthcare regulations

Data analysis

Education

High School diploma or GED

Vocational/technical education

Job description

## Case AuditorApply: Remote-OK: Full time: Posted Yesterday: 1664406**Position Purpose:** The Case Auditor ensures accuracy, consistency, and compliance within care management operations by conducting comprehensive audits of case management activities, documentation, and processes. This role supports the organizations mission to deliver high-quality, member-centered care by identifying gaps, ensuring adherence to regulatory and accreditation standards (e.g. NCQA, CMS, HEDIS, state guidelines), and driving continuous improvement initiatives.**Key Details:** This is a remote position; however, applicants must reside in Oklahoma. The ideal candidate will have experience with auditing, case management, NCQA, HEDIS, and healthcare regulatory requirements. Candidates should be computer savvy and have excellent communication, customer service, organizational, and time-management skills. The work schedule is Monday through Friday, from 8:00 AM to 5:00 PM.* Audit and Quality Review:* Conduct regular audits of care management records, documentation, and workflows to ensure compliance with internal policies and procedures, NCQA standards, and regulatory requirements.* Identify trends, discrepancies, or potential areas of risk, providing actionable recommendations to leadership.* Develop and maintain audit tools, scorecards, and tracking systems to ensure consistent and objective reviews.* Process Improvement & Compliance* Collaborate with care management leadership to address audit findings and implement corrective action plans.* Support development and updating of care management policies and procedures along with training materials based on audit results and findings.* Monitor implementation of process changes to ensure sustained compliance and improved quality outcomes.* Training & Support:* Provide feedback and guidance to care management leadership on documentation requirements, best practices, and quality standards.* Participate in training sessions to support ongoing staff education related to compliance and care management excellence.* Reporting & Data Analysis* Prepare audit reports and present findings to management with clear insights and recommendations.* Track performance metrics, compliance trends, and improvement initiatives to measure program effectiveness.Collaboration* Work closely with leadership to ensure alignment of audit activities with organizational goals.* Participate in internal and external audits as needed.* Performs other duties as assigned.* Complies with all policies and standards.**Education/Experience:** Requires a High School diploma or GED. Requires 2 - 4 years of related experience. May require vocational or technical education in addition to prior work experience.Vocation or technical education may include additional on-the-job training or continuous learning education.Pay Range: $20.39 - $34.71 per hour