Full-Time

Quality Improvement Auditor

Clinical

Posted on 2/3/2025

Centene

Centene

10,001+ employees

Provides health insurance and services

Healthcare

Compensation Overview

$55.1k - $99kAnnually

+ Incentives

Mid

Flushing, NY, USA

Hybrid work model with both remote and on-site responsibilities.

Category
Healthcare Administration & Support
Medical, Clinical & Veterinary

You match the following Centene's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • Bachelor’s degree in nursing, related field or equivalent experience
  • Requires a clinical license
  • 3+ years of nursing or quality improvement experience
Responsibilities
  • Lead clinical audits for provider medical records both remotely via electronic medical records and on site
  • Lead case reviews to assess the clinical performance provided in the provider network
  • Perform ongoing quantitative and statistical analysis of the business unit’s performance data
  • Coordinate with internal teams to assure audit requests are fully understood
  • Perform other performance and process improvement activities
  • Performs other duties as assigned
  • Complies with all policies and standards

Centene Corporation provides health insurance and services primarily to underinsured and uninsured individuals in the United States. The company offers a range of products, including medical, dental, vision, and behavioral health services, using a localized approach to meet community needs. Centene stands out from competitors by focusing on cost-effective, high-quality care and addressing social barriers to health. Its goal is to improve health outcomes while ensuring employee well-being and corporate sustainability.

Company Stage

IPO

Total Funding

N/A

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Centene's membership increased by 12% in Marketplace and 50% in Medicare PDP in 2024.
  • The expansion of low-cost plans like Fidelis Care's Essential Plan increases healthcare accessibility.
  • Centene's ICHRA plans offer customizable and transparent health insurance options.

What critics are saying

  • Increased competition in the Health Insurance Marketplace may pressure Centene's market share.
  • Reliance on government contracts exposes Centene to political and policy changes.
  • Natural disasters and new health threats could strain Centene's operational capabilities.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company offers a wide range of health insurance products through local brands.
  • Centene focuses on cost-effective, high-quality care for underinsured and uninsured individuals.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours

INACTIVE