Director, Integrated Care Audit Management

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $135.6k - $237.4k / year

⏰ Full Time

🔴 Lead

👔 Director

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Provide strategic leadership and operational oversight for internal and external regulatory audits, quality reviews, and compliance activities across Integrated Care products, markets, and businesses • Collaborate with enterprise Compliance, IT, and Care Coordination leaders on audits and compliance activities • Direct audit readiness, regulatory responses, universe submissions, audit findings, corrective action plans, and required deliverables • Coordinate and direct responses and follow-up to audit findings and draft audit reports • Monitor action plans and ensure timely submissions • Support and facilitate Medicaid and Medicare audits • Perform or coordinate audits to determine compliance and ensure corrective actions • Educate Integrated Care management and teams on risk mitigation, internal controls, and regulatory compliance • Partner with business and IT teams on universe creation and review and approve universe submissions • Support education on audit protocols across markets • Identify care coordination auditing requirements and manage resources needed for compliance • Ensure internal audit tools meet contractual, regulatory, and NCQA requirements • Present audit results and process improvement recommendations to Care Coordination leadership monthly • Provide quarterly status reports to Integrated Care Executive Leadership • Support NCQA LTSS Distinction reporting and periodic survey facilitation • Maintain strategic relationships with internal and external stakeholders • Perform other job-related duties as requested

🎯 Requirements

• Bachelor's degree in business or related field required, or equivalent years of relevant work experience may be accepted in lieu of required education • Five (5) years of healthcare operations, managed care, or audit management experience required • Three (3) years of CMS Program Audit experience required • Three (3) years of previous management experience required • Understanding of Compliance, Regulatory and Audit fundamentals related to managed care and government programs audits (CMS/HHS/DOI/Medicaid/Marketplace and Medicare) • Exceptional project management skills and ability to lead complex audits and organizational initiatives in a matrixed environment • Strategic management and leadership skills, including decision-making and time management for audit facilitation and compliance adherence • Intermediate-level proficiency in Microsoft Word, Excel, and PowerPoint • Ability to work independently and within a matrixed environment • Attention to detail and strong communication skills • Critical listening and thinking skills • CHA, CHPC, CHCA, CPHQ or similar certification preferred • May be required to work additional hours and/or outside normal business hours as needed to meet deadlines

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Remote work • Travel is not typically required