Director, Quality & Process Improvement, HEDIS Audit

Centene Corporation

Director of Quality & Process Improvement for HEDIS Audit overseeing compliance and driving process initiatives. Leading audit readiness activities and collaborating across functional units to ensure accurate submissions.

Posted 6/2/2026full-timeRemote • 🇺🇸 United StatesLead💰 $118,400 - $219,000 per yearWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

process improvement methodologiesHEDIS audit readinessprocess mappingprocess designdata analysisworkflow management softwareperformance improvement projectsauditor engagementquality assuranceresearch methodologies

Soft Skills

leadershipcollaborationcommunicationorganizational skillsstrategic thinkingproblem-solvingrelationship buildingevaluation skillsproject managementadaptability

Tools & Technologies

dashboardsauditor engagement toolsquality assurance toolstraining softwarecompliance management systemsdata gathering programsperformance tracking toolsprocess improvement softwarecommunication platformsanalytics tools

Certifications & Qualifications

Bachelor's DegreeURAC accreditationJoint Commission Accreditation

Industry Keywords

healthcareNCQAHEDIS measuresaudit processescompliance standardsprocess effectivenessinternal guidelinesexternal guidelinesbest practicesquality improvement

About the role

Key responsibilities & impact

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
Lead daily audit readiness activities, including Roadmaps, Section 5 documentation, Measure Specifications, CAHPS coordination, and auditor engagement
Oversee the administration, coordination and evaluation of quality assurance and training
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

Requirements

What you’ll need

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

Benefits

Comp & perks

competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work with remote, hybrid, field or office work schedules