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

Remote in USA

Candidates must be based in New York.

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
  • Current state’s clinical license (LPN, RN, etc.)
Responsibilities
  • Lead clinical audits for provider medical records both remotely via electronic medical records and on site to assess performance, determine trends and compile written reports summarizing findings, including clinical recommendations to assure the delivery of quality services
  • Lead case reviews to assess the clinical performance provided in the provider network, including written clinical summaries and recommendations
  • Perform ongoing quantitative and statistical analysis of the business unit’s performance data to include various contracted performance measures, service utilization and member/provider complaint and quality of care trends
  • Coordinate with internal teams to assure audit requests are fully understood, accurately compiled and delivered timely
  • Perform other performance and process improvement activities
  • Performs other duties as assigned
  • Complies with all policies and standards

Centene Corporation operates in the healthcare industry, focusing on providing health insurance and services primarily to underinsured and uninsured individuals. The company offers a variety of health insurance products, including medical, dental, vision, and behavioral health services, as well as pharmacy benefits. Centene's business model emphasizes a localized approach, allowing it to tailor its services to meet the specific needs of different communities across the United States. This strategy sets Centene apart from competitors by ensuring that care is relevant and accessible to its members. The company generates revenue through premiums collected from its 27.5 million members, amounting to $140.1 billion in 2023. Centene's goal is to improve health outcomes while managing costs, and it is committed to corporate sustainability, addressing social health barriers, and supporting employee well-being through flexible work arrangements.

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