Remote UM/CM Audit Lead – Delegated Oversight

Alignment Healthcare USA, LLC; Orange (CA); Remote; USD 78,000 - 117,000; Full time

Job summary

Alignment Health is seeking a Remote Auditor to conduct UM and CM audits for delegated entities, ensuring compliance with CMS, contractual requirements, and internal policies. You will lead audit activities, communicate findings, and drive corrective actions with delegated providers.

The role emphasizes risk-based auditing, documentation standards, and cross-functional collaboration to improve quality and performance in delegated functions.

Qualifications

• Bachelor’s degree in nursing or equivalent.

Responsibilities

• Conduct UM/CM audits in accordance with regulatory standards.
• Evaluate delegated entities’ compliance with CMS and contractual requirements.
• Maintain audit-ready documentation for regulatory reviews.
• Present audit findings with root causes and risks.
• Escalate complex issues to the Manager, Audit Administration.
• Support CAPs review and validation.
• Collaborate with stakeholders to implement improvements.

Skills

Audit planning

CMS knowledge

HIPAA compliance

Data analysis

Communication

Documentation

Risk assessment

Team collaboration

Problem solving

Attention to detail

Education

Bachelor’s in nursing or equivalent

RN or LVN license

Master’s in nursing or related field (MHA/MBA/MSN)

Tools

Microsoft Excel

EMR systems

Case management software

Job description

Alignment Health is seeking a Remote Auditor to conduct UM and CM audits for delegated entities, ensuring compliance with CMS, contractual requirements, and internal policies. You will lead audit activities, communicate findings, and drive corrective actions with delegated providers.

The role emphasizes risk-based auditing, documentation standards, and cross-functional collaboration to improve quality and performance in delegated functions.