Case Auditor

Centene Corporation•Remote-OK, OK

1d•$20 - $35•Remote

About The Position

The Case Auditor ensures accuracy, consistency, and compliance within care management operations by conducting comprehensive audits of case management activities, documentation, and processes. This role supports the organizations mission to deliver high-quality, member-centered care by identifying gaps, ensuring adherence to regulatory and accreditation standards (e.g. NCQA, CMS, HEDIS, state guidelines), and driving continuous improvement initiatives.

Requirements

Requires a High School diploma or GED.
Requires 2 - 4 years of related experience.
May require vocational or technical education in addition to prior work experience.
Vocation or technical education may include additional on-the-job training or continuous learning education.
Must reside in Oklahoma.
Experience with auditing.
Experience with case management.
Experience with NCQA.
Experience with HEDIS.
Experience with healthcare regulatory requirements.
Computer savvy.
Excellent communication skills.
Excellent customer service skills.
Excellent organizational skills.
Excellent time-management skills.

Responsibilities

Conduct regular audits of care management records, documentation, and workflows to ensure compliance with internal policies and procedures, NCQA standards, and regulatory requirements.
Identify trends, discrepancies, or potential areas of risk, providing actionable recommendations to leadership.
Develop and maintain audit tools, scorecards, and tracking systems to ensure consistent and objective reviews.
Collaborate with care management leadership to address audit findings and implement corrective action plans.
Support development and updating of care management policies and procedures along with training materials based on audit results and findings.
Monitor implementation of process changes to ensure sustained compliance and improved quality outcomes.
Provide feedback and guidance to care management leadership on documentation requirements, best practices, and quality standards.
Participate in training sessions to support ongoing staff education related to compliance and care management excellence.
Prepare audit reports and present findings to management with clear insights and recommendations.
Track performance metrics, compliance trends, and improvement initiatives to measure program effectiveness.
Work closely with leadership to ensure alignment of audit activities with organizational goals.
Participate in internal and external audits as needed.
Performs other duties as assigned.
Complies with all policies and standards.