Remote UM/CM Audit Lead (LVN/RN)

E2E Alignment Healthcare USA, LLC; California (MO); Hybrid; USD 78,000 - 117,000; Full time

Job summary

Alignment Health is seeking a Remote Auditor to support delegated UM/CM audits, ensuring compliance with CMS, contractual requirements, and internal standards. You will lead audits from planning through reporting, identifying root causes and improvement opportunities across delegated functions.

Reporting to the Manager, Audit Administration, you will communicate results clearly, validate CAPs, and collaborate with internal stakeholders to drive corrective actions and ongoing audit readiness.

Qualifications

• Bachelor’s degree in nursing or equivalent required.
• Active, unrestricted LVN/RN license required.
• 3–5 years UM/CM experience in a managed care setting.

Responsibilities

• Conduct UM/CM audits in accordance with regulatory, contractual, and industry standards.
• Prepare audit summaries and present findings to delegated entities.
• Maintain audit-ready documentation across multiple concurrent workstreams.
• Escalate irregular findings to Manager, Audit Administration.

Skills

Medicare audits

CMS requirements

UM/CM knowledge

Data analysis

Microsoft Excel

Communication skills

Education

Bachelor’s Degree in nursing or equivalent

Master’s degree in nursing or related fields

Tools

Excel

EMR systems

Job description

Alignment Health is seeking a Remote Auditor to support delegated UM/CM audits, ensuring compliance with CMS, contractual requirements, and internal standards. You will lead audits from planning through reporting, identifying root causes and improvement opportunities across delegated functions.

Reporting to the Manager, Audit Administration, you will communicate results clearly, validate CAPs, and collaborate with internal stakeholders to drive corrective actions and ongoing audit readiness.