Senior Manager, Quality Improvement, HEDIS Audit

Position Purpose: Provide leadership and direction for continuous quality improvement (QI) initiatives to improve efficiency, processes and demonstrate improved quality. Provide and analyze reports to identify trends, opportunities and recommend initiatives aimed at improving quality of care and services provided by the organization. This role will lead national HEDIS audit and submission activities, including Measure Specifics, HOQ, IDSS, PLD, XML, benchmarking, and final submission.

Key Details: 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. 

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

Strong HEDIS audit and submission experience highly preferred.

• Responsible for overall coordination of company-wide quality assessment and improvement activities.
• Oversee and coordinate with Corporate on annual file audits and other quality related initiatives to include those of a contractual nature.
• Manage and implement appropriate work tools/processes, reports and audit tools to ensure control of key processes and program characteristics.
• Recommend quality improvement opportunities based on findings and participation in developing and implementing solutions to management and the Quality Improvement Committee (QIC) and other committees, as appropriate.
• Provide feedback to rectify errors and to prevent further inconsistencies.
• Oversee monthly and quarterly reports and data to identify trends, opportunities for improvement and interventions.
• Responsible for policies, operating procedures, and aligning goals in compliance with internal and external guidelines.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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