Manager, Quality Improvement, HEDIS Audit

Centene
Missouri
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Quality & Regulatory (Non-Software)Education: bachelorsSkills: ["Quality improvement","Program management","Data analysis","Escalation management","Cross-functional communication"]

Oversee and manage the quality improvement program by leading the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team. Serve as the key escalation point for health plans, auditors, and internal partners while ensuring compliance with state, federal, and certification requirements. Review and analyze reporting data, evaluate procedures, support complaint/appeal resolution, and monitor costs and budgeting for ongoing quality improvement initiatives.

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FursaFursa
Centene
Centene
3 days ago

Manager, Quality Improvement, HEDIS Audit

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Last checked: 4 hours agoStatus: Live

Job Summary

Oversee and manage the quality improvement program by leading the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team. Serve as the key escalation point for health plans, auditors, and internal partners while ensuring compliance with state, federal, and certification requirements. Review and analyze reporting data, evaluate procedures, support complaint/appeal resolution, and monitor costs and budgeting for ongoing quality improvement initiatives.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Manager level

Key Responsibilities

  • •Oversee and manage the quality improvement program functions, leading the state HEDIS audit and regulatory submission portfolio.
  • •Serve as the key escalation point for health plans, auditors, and internal partners.
  • •Oversee state HEDIS and regulatory reporting programs and state-specific audit requirements.
  • •Review and verify reports and records to ensure compliance with government program requirements and applicable standards.
  • •Collaborate with departments to document, investigate, and resolve complaints and appeals; monitor and analyze costs and support budgeting.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kEquityPaid LeaveRemote WorkPaid Holidays

Key Requirements

  • •Bachelor’s degree in a related field or equivalent experience.
  • •3+ years of clinical, quality management, or healthcare-related experience.
  • •1 year of recent quality improvement and supervisory experience in a healthcare environment.
  • •Strong knowledge of HEDIS, NCQA requirements, Medicaid quality reporting, and healthcare regulatory submissions.
  • •Experience leading complex audit or regulatory programs with multiple concurrent deadlines is highly preferred.
Experience:HealthcareManaged careQuality management
Education:Bachelor's
Skills:Quality improvementProgram managementData analysisEscalation managementCross-functional communication

Eligibility

Work Authorization:Authorization required. Sponsorship not provided.

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn