Director, Quality & Process Improvement, HEDIS Audit

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

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

Position Purpose: Lead and direct process improvement initiatives by utilizing process improvement methodologies in the analysis of current operations and design of improvement projects across all areas that impact operations. Support NCQA HEDIS audit readiness and compliance, ensuring accurate and timely submissions.

The ideal candidate brings deep experience leading HEDIS audit readiness and execution, with a proven ability to manage complex regulatory timelines, drive cross-functional accountability, and deliver audit-ready, accurate results.

• This role leads daily audit readiness activities, including Roadmaps, Section 5 documentation, Measure Specifications, CAHPS coordination, and auditor engagement, ensuring all deliverables are accurate, complete, and submitted on time.

• Oversee the administration, coordination and evaluation of quality assurance and training, including policy and procedure development, training assessments and quality adherence auditing.

• Direct the execution of performance improvement projects, including process mapping and process design including HEDIS audit timelines and deliverables.

• Serve as primary point of contact for auditors and leadership, supporting audit communications and successful outcomes.

• Create and maintain dashboards, communications, and strategies to improve effectiveness.

• Research and develop best practices, policies, procedures, and goals in compliance with internal and external guidelines.

• Oversee data analysis and gathering processes and programs to establish costs and benefits of process effectiveness and efficiency.

• Ensure business unit is compliant with URAC and Joint Commission Accreditation standards.

• Review and implement new technological tools and processes.

• Establish strong collaborative relationships with all functional units and their leaders.

Knowledge/Experience: Bachelors Degree in related field. 6+ years of quality and process improvement experience. Healthcare industry experience preferred. Knowledge of research methodologies including measures and outcomes; knowledge of process mapping, process design, and workflow management software and applications. URAC and Joint Commission Accreditation experience preferred. Experience with NCQA HEDIS measures or audit processes highly preferred.

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