Remote RN/LVN UM/CM Auditor – Delegated Oversight

Alignment Health; Northern (KY); Hybrid; USD 78,000 - 117,000; Full time

Job summary

Alignment Health seeks a Delegation Oversight Auditor to perform Utilization Management and Case Management audits. This remote role, nationwide, requires LVN/RN credentials and delivers audit findings to improve compliance and performance across delegated entities.

You will plan, execute, and report on audits, ensuring CMS and contractual adherence while supporting corrective actions and cross-functional collaboration. Strong analytical and documentation skills are essential.

Qualifications

• Bachelor’s Degree in nursing or equivalent is required.
• Active LVN/RN license with HIPAA awareness.
• 3–5 years in UM/CM auditing within managed care; CMS knowledge.

Responsibilities

• Conduct UM/CM audits per regulatory, contractual and industry standards.
• Evaluate CMS and contractual compliance of delegated entities.
• Maintain audit-ready documentation for regulatory and internal reviews.
• Present findings, explain root causes and recommend corrective actions.
• Collaborate with internal teams to improve performance and risk management.

Skills

Medicare audits

Regulatory compliance

Data analysis

Communication skills

Attention to detail

Auditing

Risk assessment

Excel proficiency

Education

Bachelor’s Degree in nursing or equivalent

Master’s degree preferred (MHA/MPH/MBA/MSN)

Tools

Excel

EMR software

Microsoft Word

PowerPoint

Job description

Alignment Health seeks a Delegation Oversight Auditor to perform Utilization Management and Case Management audits. This remote role, nationwide, requires LVN/RN credentials and delivers audit findings to improve compliance and performance across delegated entities.

You will plan, execute, and report on audits, ensuring CMS and contractual adherence while supporting corrective actions and cross-functional collaboration. Strong analytical and documentation skills are essential.