Case Auditor

Description

Position Purpose: 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.

Key Details: This is a remote position; however, applicants must reside in Oklahoma. The ideal candidate will have experience with auditing, case management, NCQA, HEDIS, and healthcare regulatory requirements. Candidates should be computer savvy and have excellent communication, customer service, organizational, and time-management skills. The work schedule is Monday through Friday, from 8:00 AM to 5:00 PM.

• Audit and Quality Review:
• 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.
• Process Improvement & Compliance
• 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.
• Training & Support:
• 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.
• Reporting & Data Analysis
• 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.Collaboration
• 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.

Education/Experience: 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.

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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act