Director, Quality & Process Improvement, HEDIS Audit

Centene Corporation•Remote-MO, MO

1d•$118,400 - $219,000•Remote

About The Position

Centene is seeking a Director, Quality & Process Improvement, HEDIS Audit to lead and direct process improvement initiatives. This role involves utilizing process improvement methodologies to analyze current operations and design improvement projects across all areas impacting operations. A key responsibility is supporting NCQA HEDIS audit readiness and compliance, ensuring accurate and timely submissions. The ideal candidate will have extensive experience leading HEDIS audit readiness and execution, managing complex regulatory timelines, driving cross-functional accountability, and delivering accurate, audit-ready results. This position leads daily audit readiness activities, including Roadmaps, Section 5 documentation, Measure Specifications, CAHPS coordination, and auditor engagement. It also oversees quality assurance and training administration, policy and procedure development, training assessments, and quality adherence auditing. The role directs performance improvement projects, including process mapping and design, and serves as the primary point of contact for auditors and leadership. Additionally, the Director will create and maintain dashboards, communications, and strategies to improve effectiveness, research best practices, and oversee data analysis to establish costs and benefits of process improvements. Compliance with URAC and Joint Commission Accreditation standards is required, along with the implementation of new technological tools and processes. Establishing strong collaborative relationships with all functional units and their leaders is essential.

Requirements

Bachelors Degree in related field.
6+ years of quality and process improvement experience.
Knowledge of research methodologies including measures and outcomes; knowledge of process mapping, process design, and workflow management software and applications.

Nice To Haves

Healthcare industry experience preferred.
URAC and Joint Commission Accreditation experience preferred.
Experience with NCQA HEDIS measures or audit processes highly preferred.

Responsibilities

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, 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.