Case Auditor

Centene Management Company LLC; United States; Remote; USD 28,000 - 48,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off and holidays

Job summary

Centene Management Company LLC seeks a Case Auditor to ensure accuracy, consistency, and regulatory compliance across care management, auditing records and processes. The role emphasizes NCQA, CMS and state guidelines, plus driving continuous improvement.

The position is remote with residency in Oklahoma. Requirements include 2–4 years in auditing/care management, strong communication, and familiarity with NCQA/HEDIS standards. Schedule is M–F, 8:00–17:00.

Qualifications

• Requires a High School diploma or GED.
• 2–4 years of related experience in auditing or care management.
• Knowledge of NCQA, HEDIS and healthcare regulatory requirements.
• Excellent communication, organization and time management.

Responsibilities

• Conduct regular audits of care management records and workflows for compliance.
• Identify trends, discrepancies, and risks with actionable recommendations.
• Develop audit tools, scorecards and tracking systems for objective reviews.
• Collaborate to address findings and implement corrective actions.
• Prepare audit reports and present insights to management.

Skills

Auditing

Case management

NCQA standards

HEDIS

Regulatory compliance

Education

High School diploma or GED

Job description

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

Benefits

• 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.

About Centene

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 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.

Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email [e-mail]. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.