Delegate Improvement Auditor – Analyst

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🔥 0 minutes ago

🌵 Arizona, Florida, +15 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $70.2k - $120.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Medica

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1975

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• Lead complex analytical efforts supporting oversight, performance improvement, and regulatory compliance across delegated entities and internal teams • Design and maintain performance metrics evaluating delegate outcomes and compliance • Develop reports and analyses that translate complex data into actionable insights • Identify trends, risks, and improvement opportunities across delegated programs • Communicate findings to support informed decision-making • Complete comprehensive audits based on state and federal regulatory requirements • Analyze delegate performance against contractual, regulatory, and quality standards • Partner with internal teams to identify gaps and recommend improvement strategies • Monitor corrective actions and validate sustained improvement • Document findings and outcomes for consistent oversight • Support preparation for DHS and CMS site audits through data validation and reporting • Gather required documentation from delegates and internal stakeholders • Respond to audit requests with accurate, timely, and defensible information • Track audit findings and support resolution and follow-up activities • 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 • Provide guidance on metrics interpretation, reporting standards, and analysis methods • Improve analytical tools, workflows, and oversight processes • Recommend enhancements to strengthen accuracy, efficiency, and usability • Share best practices and contribute strategically to delegate improvement initiatives • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Nursing, Social Work, Healthcare Administration or related degree and/or equivalent work experience in related field • 5+ years of work experience beyond degree • Experience with care coordination, care or case management, and working with government programs strongly preferred • Audit experience • Experience and knowledge of Medicaid and SNP products • Project management or program management experience • Microsoft Office proficiency, including Word, PowerPoint and Excel • Primary home address must be within 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 offer work visa sponsorship for this role

🏖️ Benefits

• Competitive medical, dental, and vision coverage • PTO • Holidays • Paid volunteer time off • 401K contributions • Caregiver services • Other total rewards benefits