Delegated Network Compliance & Audit Manager | Managed Care & Corporate Development

UF Health; Gainesville (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

UF Health in Gainesville, FL is seeking a Delegated Network Compliance & Audit Manager to coordinate audit readiness, compliance monitoring, and governance activities for the delegated network.

You will work with Managed Care, Medical Staff Services, Provider Enrollment, Revenue Cycle, Physician Services, and regional teams to prepare for payor reviews, track CAPs, and maintain documentation, while ensuring NCQA standards alignment and audit-ready processes.

Qualifications

• Bachelor's degree required in healthcare administration, business administration, public health, or related field.
• 3–5 years of experience in healthcare operations, managed care, provider enrollment, credentialing, compliance, audit, or related function.
• Experience supporting regulatory compliance, delegated network oversight, payor audits, or compliance monitoring.

Responsibilities

• Lead coordination of delegated network audit readiness, including documentation collection and validation for payor reviews, pre-delegation assessments, and compliance evaluations.
• Coordinate onsite and virtual audits while maintaining centralized documentation and supporting materials.
• Monitor delegated network compliance with NCQA standards, payor delegation requirements, regulatory expectations, internal policies, and SLAs.
• Identify compliance gaps, operational risks, and documentation deficiencies; track trends and escalate high-risk concerns.
• Partner with operational leaders to develop, monitor, and track corrective action plans (CAPs) and remediation activities.
• Support the UF Health Delegated Network Governance Committee by coordinating meetings, agendas, documentation, minutes, and action items.
• Prepare dashboards, compliance reports, leadership updates, and governance metrics for oversight.
• Assist with development and maintenance of delegated network policies, procedures, NCQA crosswalks, and audit readiness documentation.
• Collaborate with cross-functional teams to ensure ongoing audit-readiness and compliant delegated activities.
• Drive continuous process improvement across the delegated network.

Skills

Healthcare compliance

Delegated network ops

Regulatory interpretation

Project coordination

Time management

Communication

Attention to detail

Education

Bachelor's degree in Healthcare Administration or related field

Job description

Overview

Shape the future of delegated network governance at one of Florida's leading academic health systems.

Work Style: Onsite
Location: Gainesville, FL
FTE: Full-Time (1.0 FTE)
Schedule: Monday – Friday

The Delegated Network Compliance & Audit Manager is responsible for coordinating and supporting audit, compliance, and governance activities related to UF Health’s delegated network operations, with an initial focus on delegated credentialing oversight and audit readiness.

This role serves as the primary point of coordination for delegated network compliance activities, helping ensure alignment with National Committee for Quality Assurance NCQA standards, payor delegation requirements, regulatory expectations, and internal governance practices.

The Manager partners closely with stakeholders across Managed Care, Medical Staff Services, Provider Enrollment, Revenue Cycle, Physician Services, and regional operational teams to support audit preparation, compliance monitoring, corrective action planning, and governance reporting.

This position plays an important role in supporting the UF Health Delegated Network Governance Committee by coordinating audit-related activities, maintaining compliance documentation, tracking remediation efforts, and identifying opportunities to strengthen delegated network oversight.

This position does not directly perform credentialing or provider enrollment functions but works closely with operational teams to ensure delegated activities remain compliant, consistent, and audit-ready.

While initially focused on audit readiness, compliance monitoring, and governance support, this role may evolve over time to support broader delegated network governance and operational oversight initiatives.

Responsibilities

Key Responsibilities

• Lead coordination of delegated network audit readiness, including documentation collection, evidence validation, and audit support for payor reviews, pre-delegation assessments, and compliance evaluations.
• Coordinate onsite and virtual audits while maintaining centralized audit documentation, repositories, and supporting materials.
• Monitor delegated network compliance with NCQA standards, payor delegation requirements, regulatory expectations, internal policies, and service level agreements (SLAs).
• Identify compliance gaps, operational risks, and documentation deficiencies while tracking trends and escalating high‑risk concerns as appropriate.
• Partner with operational leaders to develop, monitor, and track corrective action plans (CAPs), remediation activities, and audit follow‑up efforts.
• Support the UF Health Delegated Network Governance Committee by coordinating meetings, agendas, documentation, minutes, action items, and governance records.
• Prepare dashboards, compliance reports, leadership updates, and governance metrics to support organisational oversight and decision‑making.
• Assist with the development, maintenance, and continuous improvement of delegated network policies, procedures, NCQA crosswalks, and audit readiness documentation.
• Collaborate with Managed Care, Medical Staff Services, Provider Enrollment, Revenue Cycle, Physician Services, and regional operational teams to ensure delegated activities remain compliant, consistent, and audit‑ready.
• Serve as a trusted resource on delegated compliance, governance, and audit readiness while driving continuous process improvement across the delegated network.

Qualifications

Minimum Qualifications

Education

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field, or an equivalent combination of education and relevant experience.

Experience

• Three (3) to five (5) years of experience in healthcare operations, managed care, provider enrollment, credentialing, compliance, audit, or a related healthcare function.
• Experience supporting regulatory compliance, delegated network oversight, payor audits, or compliance monitoring.
• Strong understanding of healthcare operational workflows and compliance standards.

Preferred Qualifications

• Experience with National Committee for Quality Assurance (NCQA) standards, delegated credentialing, or payor delegation oversight.
• Experience supporting audit programs, governance committees, or organizational compliance initiatives.
• Experience working within an academic health system or large, multi-entity healthcare organization.

Knowledge, Skills & Abilities

• Understanding of healthcare audit, compliance, and governance principles.
• Knowledge of delegated credentialing and delegated network operations.
• Ability to interpret regulatory requirements, delegation agreements, and payor expectations.
• Strong project coordination, organization, and time management skills.
• Excellent written, verbal, and interpersonal communication skills.
• Strong analytical, critical thinking, and problem‑solving abilities.
• Ability to manage multiple priorities and meet deadlines in a fast‑paced, complex environment.
• Exceptional attention to detail with strong follow‑through and accountability.