Health Plan Compliance Auditor

Oak Street Health, part of CVS Health; Springfield (IL); On-site; USD 44,000 - 94,000; Full time

Benefits offered by this job

Health insurance

Vision and dental benefits

401K match options

Paid time off and sick leave

Job summary

Oak Street Health in Springfield, IL, is seeking an Associate, Delegation Compliance to support CMS, NCQA, and Medicare Part C compliance across care management and utilization management teams.

You will help develop policies, audit tools, training materials, and CAPs/PIPs, coordinating with regulators and internal leadership to drive quality and ensure HIPAA compliance.

Qualifications

• Bachelor’s degree in Healthcare Administration, Compliance, or related field.
• 1–2 years of compliance experience with care management, utilization management, auditing, reporting, action plans, and training.
• Strong understanding of healthcare laws, NCQA requirements, and Medicare Part C compliance.
• Experience working with regulators on compliance audits.
• Ability to work independently and with others.
• Excellent teamwork and communication.
• US work authorization.
• Being Oaky embodies positive energy and accountability.

Responsibilities

• Possesses knowledge of CMS, contractual, accreditation, federal, state, and business requirements and ensures compliance.
• Collaborates with leadership to develop, implement, and maintain policies and procedures for assigned programs.
• Collaborates with leadership to develop auditing and monitoring tools for staff and program audits.
• Collaborates with payers, serves as SME for compliance-related activities.
• Contributes to reports used by internal and external leadership.
• Provides input on auditing results, trends and improvement activities.
• Develops and revises training materials based on QA results.
• Analyzes processes and KPIs to assess compliance risk and internal control.
• Demonstrates HIPAA compliance and ethical practices.
• Develops CAPs and PIPs and ensures ongoing monitoring.
• Performs other duties as assigned.

Skills

Regulatory compliance

Healthcare laws

Auditing & reporting

Analytical thinking

Communication & teamwork

Education

Bachelor’s degree in Healthcare Administration or related field

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Role description: The Associate, Delegation Compliance supports compliance activities for Oak Street Health’s internal care management and utilization management teams. They partner with operational leadership to implement and monitor ongoing quality improvement activities, lead external compliance and accreditation survey processes, and leverage program knowledge and analytical skills to effectively coordinate all compliance activities.

Responsibilities

• Possesses and demonstrates knowledge of CMS, contractual, accreditation, federal, state, and business requirements for assigned programs, and ensures compliance with program requirements
• Collaborates with leadership to develop, implement, and maintain policies and procedures for assigned programs
• Collaborates with leadership to develop and execute auditing and monitoring tools utilized for staff and program audits
• Collaborates with payers, serves as SME for compliance-related activities
• Contributes to reports used by internal and external leadership
• Provides input and valuable feedback on auditing results, trends and improvement activities
• Recommends process improvement, interventions, and assists with implementation
• Develops and revises training materials based on QA results
• Analyzes processes and key performance indicators to assess compliance risk, internal control, and overall effectiveness and efficiency
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practices
• Develops Corrective Action Plans (CAPs) and Performance Improvement Plans (PIPs) and is accountable for the adequacy of operational responses and ongoing monitoring
• Performs other job duties, as assigned.

What We’re Looking For

• 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 skills, critical thinking skills, and organizational skills
• US work authorization
• Someone who embodies “Being Oaky”

What does being Oaky look like?

• Radiating positive energy
• Assuming good intentions
• Creating an unmatched patient experience
• Driving clinical excellence
• Taking ownership and delivering results
• Being relentlessly determined

Benefits

• Mission-focused career impacting change and measurably improving health outcomes for Medicare patients
• Paid vacation, sick time, and investment/retirement 401K match options
• Health insurance, vision, and dental benefits
• Opportunities for leadership development and continuing education stipends
• New centers and flexible work environments
• Opportunities for high levels of responsibility and rapid advancement Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply. Learn more at www.oakstreethealth.com/diversity-equity-and-inclusion-at-oak-street-health

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$43,888.00 - $93,574.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

We anticipate the application window for this opening will close on: 09/13/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.