Manager, Quality Improvement, HEDIS Audit

Centene Corporation; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Remote work from home nationwide

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules (remote/hybrid

Field or office schedules

Job summary

Centene Corporation seeks a Quality Improvement professional to oversee the QA program, leading state HEDIS audits and regulatory submissions. You will support staff, coordinate with departments, and ensure compliance with government requirements and NCQA standards.

Ideal candidates have 3+ years in quality management within managed care, with supervision experience and a strong grasp of HEDIS requirements and complex audit programs.

Qualifications

• Bachelor's degree in related field or equivalent experience.
• 3+ years clinical, quality management or healthcare experience.
• 1 year of recent quality improvement and supervisory experience in a healthcare environment.
• Strong knowledge of HEDIS, NCQA requirements and Medicaid quality reporting.
• Experience leading complex audit/regulatory programs with multiple deadlines.

Responsibilities

• Oversee and manage the quality improvement program.
• Lead the state HEDIS audit and regulatory submission portfolio.
• Provide support to staff and coordinate with departments to enable daily QA functions.
• Serve as escalation point for Health Plans, auditors and internal partners.
• Review and verify reports for compliance with government requirements.
• Develop and implement improved procedures to meet standards.
• Collaborate with departments to address complaints and appeals.
• Monitor costs and participate in budget preparation.

Skills

HEDIS knowledge

NCQA requirements

Regulatory reporting

Quality improvement

Auditing

Education

Bachelor's degree in related field

Tools

Regulatory reporting software

Audit management tools

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Applicants for this job have the flexibility to work remote from home anywhere in the United States.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Position Purpose: Oversee and manage the functions of the quality improvement program, specifically leading the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team. Providing 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 data such as new projects, status of work in progress, and problems encountered, required for planning work function activities. Verify data to be submitted 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 for accomplishing the assigned work functions objectives to develop and implement improved procedures and practices and to ensure compliance with required standards.
• Collaborate with appropriate departments to document, investigate and resolve formal or informal complaints and appeals in accordance with Company and State policies, procedures and requirements.
• Monitor and analyze costs and participate in the preparation of the budget.

Education/Experience: Bachelor's degree in related field or equivalent experience. 3+ years clinical, quality management or healthcare related experience and 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.

License/Certification: Certain states may require a formal certification in quality improvement, risk management, or another parallel field.

Pay Range: $87,700.00 - $157,800.00 per year

Centene offers a comprehensive benefits package including: 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.

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