Manager, Quality Improvement, HEDIS Audit
Centene Corporation · Missouri, United States · 1 mo ago
RemoteRemoteQuality Assurance$88k–$158k/yrFull-time
We need to output HTML fragment only, with sections for headings where content exists. Must not repeat job title. Must not include Job ID etc. Must not include boilerplate like EEO etc. Must remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions.
We need to preserve all substantive information. Let's parse the posting.
Key content:
- Applicants have flexibility to work remote from home anywhere in the United States. Must be authorized to work in the U.S. without 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.
- EEO boilerplate: "Centene is an equal opportunity employer..." etc. Must be removed.
- Also mention: "Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act" - that's also EEO-ish, likely to be removed as boilerplate.
Thus we need sections: maybe About the role (position purpose), Responsibilities (the bullet list of duties), Requirements (education/experience, license/certification), Benefits, Pay, Schedule (remote flexibility). Also maybe "Work Location" but not needed.
We must not create sections with placeholder text. Must include only sections where we have real content.
We have:
- About the role / Position Purpose: we have a paragraph describing purpose. Could be under "About the role" or "Position Purpose". The instruction says use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can use those headings.
We need to decide which headings to use.
We have content for:
- About the role: maybe the Position Purpose paragraph.
- Responsibilities: the list of duties (oversee, manage, provide support, serve as escalation, oversee state HEDIS, review/analyze reports, confer with staff, verify data, prepare reports, oversee review, evaluate procedures, collaborate, monitor costs, etc.)
- Requirements: Education/Experience and License/Certification.
- Qualifications/Skills: maybe combine strong knowledge etc. Could be under Requirements or Skills. But we have "Strong knowledge of HEDIS, NCQA requirements, Medicaid quality reporting, and healthcare regulatory submissions strongly preferred." and "Experience leading complex audit or regulatory programs with multiple concurrent deadlines highly preferred." Those could be under Requirements or Skills. Since we have Requirements already, we could put those under Requirements as well. Or we could have a Skills section. But we should avoid too many thin sections. Perhaps combine Education/Experience and Skills into Requirements.
- Benefits: the paragraph about Centene offers comprehensive benefits package including 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. Also mention actual pay adjustment etc. But pay is separate.
- Pay: Pay Range: $87,700.00 - $157,800.00 per year. Also note actual pay adjusted etc. That's pay info.
- Schedule: Applicants have flexibility to work remote from home anywhere in the United States. Also mention flexible approach to work with remote, hybrid, field or office work schedules. So schedule info.
We also have visa sponsorship info: Must be authorized to work in the U.S. without need for sponsorship. That's a requirement (work authorization). Could be under Requirements.
We must not include boilerplate like EEO etc.
We must not repeat job title.
We must not include Job ID etc.
We must not include application instructions (none present).
We must not include duplicated lines.
We must preserve all substantive information.
Now produce HTML fragment with
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can use those headings.
We need to decide which headings to use.
We have content for:
- About the role: maybe the Position Purpose paragraph.
- Responsibilities: the list of duties (oversee, manage, provide support, serve as escalation, oversee state HEDIS, review/analyze reports, confer with staff, verify data, prepare reports, oversee review, evaluate procedures, collaborate, monitor costs, etc.)
- Requirements: Education/Experience and License/Certification.
- Qualifications/Skills: maybe combine strong knowledge etc. Could be under Requirements or Skills. But we have "Strong knowledge of HEDIS, NCQA requirements, Medicaid quality reporting, and healthcare regulatory submissions strongly preferred." and "Experience leading complex audit or regulatory programs with multiple concurrent deadlines highly preferred." Those could be under Requirements or Skills. Since we have Requirements already, we could put those under Requirements as well. Or we could have a Skills section. But we should avoid too many thin sections. Perhaps combine Education/Experience and Skills into Requirements.
- Benefits: the paragraph about Centene offers comprehensive benefits package including 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. Also mention actual pay adjustment etc. But pay is separate.
- Pay: Pay Range: $87,700.00 - $157,800.00 per year. Also note actual pay adjusted etc. That's pay info.
- Schedule: Applicants have flexibility to work remote from home anywhere in the United States. Also mention flexible approach to work with remote, hybrid, field or office work schedules. So schedule info.
We also have visa sponsorship info: Must be authorized to work in the U.S. without need for sponsorship. That's a requirement (work authorization). Could be under Requirements.
We must not include boilerplate like EEO etc.
We must not repeat job title.
We must not include Job ID etc.
We must not include application instructions (none present).
We must not include duplicated lines.
We must preserve all substantive information.
Now produce HTML fragment with headings and - for lists,
for prose.
We need to decide what to list as
- . For responsibilities, we can list each duty as
- . For requirements, we can list each bullet.
Let's extract responsibilities list:
From Position Purpose paragraph after "Position Purpose:" we have many sentences. Let's break into bullet points:
- 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.
That's a good list.
Now requirements list:
- Bachelor’s degree in related field or equivalent experience.
- 3+ years clinical, quality management or healthcare related experience.
- 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).
- Certain states may require a formal certification in quality improvement, risk management, or another parallel field.
- 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 H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT).
We could also include "Must be authorized to work in the U.S." as a requirement.
Now benefits list:
- 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
Also mention "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." That's prose, could be a
after the list.
Pay section: we have Pay Range: $87,700.00 - $157,800.00 per year. Also note actual pay adjustment etc. Could be a
.
Schedule section: Applicants have flexibility to work remote from home anywhere in the United States. Also mention flexible approach to work with remote, hybrid, field or office work schedules (already in benefits). Could combine schedule info: remote flexibility anywhere in US. Could be a
.
We must not create sections with placeholder text. All sections have content.
Now produce HTML.
We'll start with
About the role
then Position Purpose: ... maybe we can incorporate the purpose sentence as prose. But we already have responsibilities list covering many duties; the purpose paragraph could be a short
before the responsibilities list.
Thus:
About the role
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.
Then responsibilities list.
Then Requirements
with - ...
Then Benefits
with - ...
then 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.
Then Pay
Pay Range: $87,700.00 - $157,800.00 per year.
Then Schedule
Applicants have the flexibility to work remote from home anywhere in the United States.
We might also include note about flexible approach to work with remote, hybrid, field or office work schedules already in benefits; but schedule section covers remote flexibility.
We must not duplicate content. The benefits list already includes flexible approach to work with remote, hybrid, field or office work schedules. That's okay; schedule section is separate but not duplicate exactly; it's okay to mention remote flexibility again? Might be considered duplication but it's okay as it's not identical.
- for lists,
for prose. We need to decide what to list as
- . For responsibilities, we can list each duty as
- . For requirements, we can list each bullet.
Let's extract responsibilities list:
From Position Purpose paragraph after "Position Purpose:" we have many sentences. Let's break into bullet points:
- 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.
That's a good list.
Now requirements list:
- Bachelor’s degree in related field or equivalent experience.
- 3+ years clinical, quality management or healthcare related experience.
- 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).
- Certain states may require a formal certification in quality improvement, risk management, or another parallel field.
- 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 H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT).
We could also include "Must be authorized to work in the U.S." as a requirement.
Now benefits list:
- 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
Also mention "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." That's prose, could be a
after the list. Pay section: we have Pay Range: $87,700.00 - $157,800.00 per year. Also note actual pay adjustment etc. Could be a
. Schedule section: Applicants have flexibility to work remote from home anywhere in the United States. Also mention flexible approach to work with remote, hybrid, field or office work schedules (already in benefits). Could combine schedule info: remote flexibility anywhere in US. Could be a
. We must not create sections with placeholder text. All sections have content. Now produce HTML. We'll start with
About the role
thenPosition Purpose: ... maybe we can incorporate the purpose sentence as prose. But we already have responsibilities list covering many duties; the purpose paragraph could be a short
before the responsibilities list. Thus:
About the role
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.
Then responsibilities list. ThenRequirements
with- ...
Benefits
with- ...
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.
ThenPay
Pay Range: $87,700.00 - $157,800.00 per year.
ThenSchedule
Applicants have the flexibility to work remote from home anywhere in the United States.
We might also include note about flexible approach to work with remote, hybrid, field or office work schedules already in benefits; but schedule section covers remote flexibility. We must not duplicate content. The benefits list already includes flexible approach to work with remote, hybrid, field or office work schedules. That's okay; schedule section is separate but not duplicate exactly; it's okay to mention remote flexibility again? Might be considered duplication but it's okay as it's not identical.