质量改进经理, HEDIS审计
Manager, Quality Improvement, HEDIS Audit
申请人可以远程在家工作，地点需在美国境内。
必须已获得在美国工作的授权，无需当前或未来通过基于就业的签证赞助。此职位不提供任何签证类型的赞助，包括H-1B、L-1、O-1、H-1B1、F-1、J-1、OPT或CPT。
职位职责：负责监督和管理质量改进计划的功能，特别是领导质量审计与提交团队内的州级HEDIS审计和监管提交组合。为员工提供支持，并与各部门和员工沟通，以促进日常质量改进功能。
- 作为健康计划、审计师和内部合作伙伴的关键升级点。
- 监督州级HEDIS和监管报告项目以及特定州的审计要求。
- 审阅并分析报告、记录和指令。
- 与员工协商以获取数据，例如新项目、进行中的工作状态和遇到的问题，用于规划工作职能活动。根据政府项目要求验证要提交的数据，并确保符合州、联邦和认证要求。
- 准备工作报告和记录供管理层参考。
- 监督报告的审查和分析。
- 评估现有流程和实践，以实现指定的工作职能目标，制定并实施改进的流程和实践，并确保符合所需标准。
- 与相关部门合作，根据公司和州政策、程序和要求，记录、调查并解决正式或非正式的投诉和申诉。
- 监控成本并参与预算准备。
教育/经验：相关领域的学士学位或同等经验。3年以上临床、质量管理或医疗相关经验，以及在医疗环境中最近1年的质量改进和监督经验，优先考虑管理护理领域。强烈建议熟悉HEDIS、NCQA要求、Medicaid质量报告和医疗监管提交。有领导复杂审计或监管项目的经历，同时处理多个并行截止日期者优先。
执照/认证：某些州可能需要质量改进、风险管理方面的正式认证。
查看英文原文
Applicants for this job have the flexibility to work remote from home anywhere in the United States.
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.
Position Purpose: Oversee and manage the functions of the quality improvement program, specifically leading the state HEDIS audit and regulatory submission portfolio within the Quality Audit & Submission team. Providing support to staff and communicate with departments and staff to facilitate daily quality improvement functions.
- Serve as key escalation point for Health Plans, auditors, and internal partners.
- Oversee state HEDIS and regulatory reporting programs and state-specific audit requirements.
- Review and analyze reports, records and directives.
- Confer with staff to obtain data such as new projects, status of work in progress, and problems encountered, required for planning work function activities. Verify data to be submitted in accordance with government program requirements and ensure compliance with state, federal and certification requirements.
- Prepare reports and records on work function activities for management.
- Oversee the review and analysis of reports.
- Evaluate current procedures and practices for accomplishing the assigned work functions objectives to develop and implement improved procedures and practices and to ensure compliance with required standards.
- Collaborate with appropriate departments to document, investigate and resolve formal or informal complaints and appeals in accordance with Company and State policies, procedures and requirements.
- Monitor and analyze costs and participate in the preparation of the budget.
Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years clinical, quality management or healthcare related experience and 1 year of recent quality improvement and supervisory experience in a healthcare environment, preferably managed care. Strong knowledge of HEDIS, NCQA requirements, Medicaid quality reporting, and healthcare regulatory submissions strongly preferred. Experience leading complex audit or regulatory programs with multiple concurrent deadlines highly preferred.
License/Certification: Certain states may require a formal certification in quality improvement, risk management, or another parallel field.
Pay Range: $87,700.00 - $157,800.00 per year
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
Originally posted on Himalayas