Director, Integrated Care Audit Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Offer strategic direction and operational oversight for both internal and external regulatory audits, quality assessments, and compliance initiatives across Integrated Care products, markets, and businesses.

• Work collaboratively with enterprise Compliance, IT, and Care Coordination leaders on audits and compliance efforts.

• Oversee audit preparedness, regulatory responses, universe submissions, audit outcomes, corrective action plans, and necessary deliverables.

• Manage and coordinate responses and follow-ups to audit findings, including the drafting of audit reports.

• Track action plans and guarantee timely submissions.

• Assist in and facilitate audits for Medicaid and Medicare.

• Conduct or coordinate audits to assess compliance and ensure corrective measures are implemented.

• Train Integrated Care management and teams on risk mitigation, internal controls, and regulatory compliance.

• Collaborate with business and IT teams on universe development and review and approve universe submissions.

• Support training on audit protocols across various markets.

• Identify auditing requirements for care coordination and manage the necessary resources for compliance.

• Ensure that internal audit tools comply with contractual, regulatory, and NCQA standards.

• Present audit findings and process improvement suggestions to Care Coordination leadership on a monthly basis.

• Deliver quarterly status updates to Integrated Care Executive Leadership.

• Assist with NCQA LTSS Distinction reporting and facilitate periodic surveys.

• Maintain strategic relationships with both internal and external stakeholders.

• Perform additional job-related tasks as assigned.

⛳️ Requirements

• A Bachelor's degree in business or a related field is required, or equivalent years of relevant work experience may be accepted in place of the required education.

• A minimum of five (5) years of experience in healthcare operations, managed care, or audit management is required.

• At least three (3) years of experience with CMS Program Audits is necessary.

• A minimum of three (3) years of prior management experience is required.

• Knowledge of Compliance, Regulatory, and Audit principles related to managed care and audits for government programs (CMS/HHS/DOI/Medicaid/Marketplace and Medicare) is essential.

• Outstanding project management abilities and the capacity to lead complex audits and organizational initiatives within a matrixed setting.

• Strong strategic management and leadership capabilities, including decision-making and time management skills for audit facilitation and compliance adherence.

• Intermediate proficiency in Microsoft Word, Excel, and PowerPoint.

• Capability to work independently and within a matrixed environment.

• Keen attention to detail and excellent communication skills.

• Strong critical listening and analytical thinking skills.

• CHA, CHPC, CHCA, CPHQ, or a similar certification is preferred.

• Availability to work additional hours and/or outside regular business hours as needed to meet deadlines may be required.

🏝️ Benefits

• A bonus linked to both company and individual performance may be available.

• A substantial and comprehensive total rewards package.

• Opportunity for remote work.

• Travel is generally not required.