Delegate Improvement Auditor – Analyst

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Lead intricate analytical initiatives that support oversight, enhance performance, and ensure regulatory compliance across delegated entities and internal teams.

• Design and uphold performance metrics that assess delegate outcomes and compliance.

• Create reports and analyses that convert complex data into actionable insights.

• Identify trends, risks, and opportunities for improvement across delegated programs.

• Effectively communicate findings to facilitate informed decision-making.

• Conduct comprehensive audits in alignment with state and federal regulatory requirements.

• Evaluate delegate performance against contractual, regulatory, and quality standards.

• Collaborate with internal teams to pinpoint gaps and propose improvement strategies.

• Oversee corrective actions and verify sustained improvements.

• Document findings and outcomes to ensure consistent oversight.

• Assist in preparation for DHS and CMS site audits through data validation and reporting.

• Collect necessary documentation from delegates and internal stakeholders.

• Respond to audit inquiries with precise, timely, and defensible information.

• Track audit findings and aid in resolution and follow-up actions.

• Align information across clinical, operational, compliance, and analytics teams.

• Ensure data consistency across reports, submissions, and oversight tools.

• Address discrepancies through root-cause analysis and coordination efforts.

• Provide guidance on the interpretation of metrics, reporting standards, and analysis methodologies.

• Enhance analytical tools, workflows, and oversight processes.

• Suggest improvements to boost accuracy, efficiency, and usability.

• Share best practices and strategically contribute to delegate improvement initiatives.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor's degree in Nursing, Social Work, Healthcare Administration, or a related field, along with equivalent work experience in a related area.

• 5+ years of work experience following the completion of degree.

• Preferably experienced in care coordination, care or case management, and working with government programs.

• Audit experience is required.

• Familiarity with Medicaid and SNP products is essential.

• Background in project management or program management is preferred.

• Proficiency in Microsoft Office, including Word, PowerPoint, and Excel.

• Primary residence must be in a state where Medica is registered as an employer: AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

• Must be legally authorized to work in the United States at the time of application.

• Medica does not provide work visa sponsorship for this position.

🏝️ Benefits

• Competitive medical, dental, and vision insurance.

• Paid time off (PTO).

• Holidays.

• Paid volunteer time off.

• 401K contributions.

• Caregiver services.

• Additional total rewards benefits.