Health Plan Compliance Auditor

Job not on LinkedIn

🔥 15 hours ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $43.9k - $93.6k / year

⏰ Full Time

🟢 Junior

🔎 Auditor

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Support compliance activities for Oak Street Health’s internal care management and utilization management teams • Partner with operational leadership to implement and monitor ongoing quality improvement activities • Lead external compliance and accreditation survey processes • Coordinate compliance activities using program knowledge and analytical skills • Ensure compliance with CMS, contractual, accreditation, federal, state, and business requirements • Develop, implement, and maintain policies and procedures • Develop and execute auditing and monitoring tools for staff and program audits • Collaborate with payers and serve as a subject matter expert for compliance activities • Contribute to reports for internal and external leadership • Analyze auditing results, trends, processes, and key performance indicators • Recommend process improvements and interventions and assist with implementation • Develop and revise training materials based on QA results • Develop Corrective Action Plans and Performance Improvement Plans • Monitor operational responses and ongoing compliance • Consistently comply with HIPAA regulations, professional conduct, and ethical practices • Perform other assigned duties

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Compliance, related field, or equivalent experience • 1-2 years of compliance experience dealing with care management requirements, utilization management requirements, auditing, reporting processes, action plans, and compliance training preferred • Strong understanding of healthcare laws, NCQA requirements, and Medicare Part C regulatory compliance in a managed care organization or hospital health care system setting • Experience working with regulators on compliance audits • Ability to work independently and with others • Experience in building and supporting strong teamwork and collaborative communication • Ability to work under pressure with multiple deadlines and priorities • Strong problem-solving, critical thinking, and organizational skills • US work authorization • Commitment to “Being Oaky” values

🏖️ Benefits

• Paid vacation and sick time • Investment/retirement 401K match options • Health insurance, vision, and dental benefits • Leadership development opportunities • Continuing education stipends • New centers and flexible work environments • Opportunities for high levels of responsibility and rapid advancement • Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • CVS Health bonus, commission or short-term incentive program eligibility