Remote Senior HEDIS Quality & Audit Lead

Centene Management Company LLC; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/office work

Job summary

Centene Management Company LLC is seeking a Senior HEDIS Quality & Audit Analyst to lead enterprise HEDIS audit workstreams, interpret complex regulatory requirements, and ensure audit-defensible submission documentation aligned with NCQA and CMS expectations. The role requires 4+ years in HEDIS or regulated healthcare audits, with project management experience and a Bachelor’s degree (Master’s preferred).

Remote work within the continental United States is supported, with collaboration across

Qualifications

• 4+ years of experience in HEDIS, quality audits, or regulated healthcare environments.
• Project management experience in HEDIS, regulatory, audit, or quality improvement preferred.
• Bachelor's degree required; Master's degree preferred.

Responsibilities

• Lead complex NCQA audit workstreams, including roadmaps, documentation, and auditor communications.
• Interpret federal/state regulatory requirements and apply them to HEDIS documentation and data use.
• Identify, assess, and mitigate audit and submission risks; conduct root cause analyses and implement corrective actions.
• Support CMS submission activities, including PLD coordination, testing validation, and final submission readiness.
• Develop, refine, and maintain enterprise standards and templates to ensure audit-defensible outcomes.

Skills

HEDIS knowledge

Audit leadership

Regulatory interpretation

Risk assessment

Root cause analysis

Stakeholder communication

Project management

Education

Bachelor's degree in healthcare or related field

Master's degree in healthcare or related field (preferred)

Job description

Centene Management Company LLC is seeking a Senior HEDIS Quality & Audit Analyst to lead enterprise HEDIS audit workstreams, interpret complex regulatory requirements, and ensure audit-defensible submission documentation aligned with NCQA and CMS expectations. The role requires 4+ years in HEDIS or regulated healthcare audits, with project management experience and a Bachelor’s degree (Master’s preferred).

Remote work within the continental United States is supported, with collaboration across