Remote Director, Integrated Care Audit & Compliance

CareSource; Northern (KY); Remoto; USD 136.000 - 237.000; Tempo pieno

Descrizione del lavoro

CareSource is seeking a Director, Integrated Care Audit Management to provide strategic leadership for internal and external regulatory audits, quality reviews, and compliance activities. You will align audit processes with CMS, Medicaid, Medicare, and NCQA requirements across Integrated Care products and markets.

You will lead audit readiness, coordinate regulatory responses, and drive corrective action plans, while educating stakeholders to strengthen internal controls and risk mitigation.

Competenze

• Bachelor's degree in business or related field required.
• Master's degree preferred.
• 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 is required.

Mansioni

• Collaborate with enterprise Compliance for all Federal, State and product specific audits conducted by regulators of Medicaid and Medicare programs for operationalization within Integrated Care product across all markets
• Coordinate and direct all responses and follow-up to audit findings and draft audit reports. Monitor follow-up action plans on all audit findings for Integrated Care product and ensure timely submission
• Minimize risk to the company by responding to or supporting and assisting with the facilitation of Medicaid and Medicare audits in coordination with Compliance leaders
• Perform or coordinate specific audits to determine compliance, and if necessary, ensuring appropriate actions are taken to put the Integrated Care product in compliance
• Seek opportunities to educate the Integrated Care management and team on the importance of risk mitigation, effective internal controls and compliance with applicable regulations

Conoscenze

Regulatory compliance

Audit management

Project management

Stakeholder engagement

Formazione

Bachelor's degree in business or related field

Master's degree in business or related field

Strumenti

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Descrizione del lavoro

CareSource is seeking a Director, Integrated Care Audit Management to provide strategic leadership for internal and external regulatory audits, quality reviews, and compliance activities. You will align audit processes with CMS, Medicaid, Medicare, and NCQA requirements across Integrated Care products and markets.

You will lead audit readiness, coordinate regulatory responses, and drive corrective action plans, while educating stakeholders to strengthen internal controls and risk mitigation.