Remote Clinical Data & Audit Strategist

Centene Management Company LLC

California

Hybrid

USD 46,000 - 84,000

Full time

14 days+

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Benefits offered by this job

Competitive pay

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Management Company LLC is seeking a Clinical Data and Audit Consultant responsible for the clinical content in data collection, audits, and account implementations across Clinical Operations to ensure high-quality tracking and performance of service teams.

The role requires a CA-licensed Registered Nurse with experience in clinical data analysis, regulatory reporting (HEDIS/NCQA/URAC), and process improvement. Hybrid/field or office work schedules are available, with competitive benefits.

Qualifications

BA/BS in Psychology, Nursing or related clinical field; Masters in Social Work, Counseling, Nursing, or related field preferred.
Three to five years case management or related clinical experience.
Two to three years experience conducting business studies, recommending solutions and/or business analysis, preferably in Healthcare.

Responsibilities

Gathers and analyzes data, creates workflows, coordinates audits, and documents business processes to meet clinical, procedural, account, and regulatory requirements.
Leads data analysis projects to examine clinically related issues and track productivity and quality measures.
Reviews data for compliance reporting (HEDIS, URAC, NCQA) and related reporting for clinical service teams.