Quality Improvement Lead: HEDIS & Regulatory Audits (Remote)

Embedded Shishya; United States; Remote; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a Quality Improvement Manager to oversee the HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team. You will provide support across departments, communicate progress, and ensure compliance with state and federal requirements.

In this role you will lead complex audits, manage multiple deadlines, monitor budgets, and collaborate to drive continuous improvement in healthcare quality measures nationwide.

Qualifications

• 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 healthcare.
• Strong knowledge of HEDIS, NCQA requirements, Medicaid quality reporting, and healthcare regulatory submissions.

Responsibilities

• Serve as 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.
• Collaborate with staff to obtain data for planning work function activities and verify data for government program requirements.
• Prepare reports and records on work function activities for management.
• Oversee review and analysis of reports and evaluate procedures to improve compliance and efficiency.

Skills

HEDIS knowledge

NCQA requirements

Healthcare regulatory submissions

Quality improvement leadership

Education

Bachelor’s degree

Job description

Centene is seeking a Quality Improvement Manager to oversee the HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team. You will provide support across departments, communicate progress, and ensure compliance with state and federal requirements.

In this role you will lead complex audits, manage multiple deadlines, monitor budgets, and collaborate to drive continuous improvement in healthcare quality measures nationwide.