Director, Integrated Care Audit Management

Job Summary The Director, Integrated Care Audit Management provides strategic leadership and operational oversight for internal and external regulatory audits, quality reviews, and compliance activities across all Integrated Care products, markets, & businesses. In partnership with enterprise Compliance, IT, and Care Coordination leaders, this role directs audit readiness, coordinates regulatory responses and universe submissions, evaluates audit findings, and ensures timely completion of corrective action plans and other required deliverables. The Director identifies and mitigates regulatory and operational risk by strengthening internal controls, aligning audit tools and processes with contractual, federal, state, CMS, Medicaid, Medicare, and NCQA requirements, and promoting consistent application of audit protocols. Through education, collaboration, and strategic stakeholder engagement, the Director advances audit preparedness, regulatory compliance, accountability, and continuous process improvement throughout the Integrated Care product. Essential Functions 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 marketsCoordinate 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 submissionMinimize risk to the company by responding to or supporting and assisting with the facilitation of Medicaid and Medicare audits in coordination with Compliance leadersPerform or coordinate specific audits to determine compliance, and if necessary, ensuring appropriate actions are taken to put the Integrated Care product in complianceSeek opportunities to educate the Integrated Care management and team on the importance of risk mitigation, effective internal controls and compliance with applicable regulationsPartner with the business and IT teams for all universe creations. Review and approval of all universe submissions for the Integrated Care product for all marketsSupport the education of audit protocols for all marketsEnsure accurate/timely completion of regulatory/compliance tasks requested for all external auditsIdentify care coordination auditing requirements for each Integrated Care product market and manage resources needed to drive complianceEnsure internal audit tools for care coordination meet the contractual, regulatory and NCQA requirements for Integrated Care products for all marketsPresent audit results and recommendations for process improvements to Care Coordination leadership monthlyProvide at least quarterly status reports for the Integrated Care product Executive Leadership regarding internal & external audits and related issuesSupport the NCQA LTSS Distinction reporting requirements, as well as facilitation of periodic surveyMaintain positive and strategic relationships with internal and external stakeholdersPerform any other job related duties as requested. Education And Experience Bachelor's degree in business or related field required Master's degree in business or related field preferred Equivalent years of relevant work experience may be accepted in lieu of required educationFive (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, audit management experience within healthcare operations preferred Competencies, Knowledge and Skills: Demonstrated understanding of Compliance, Regulatory and Audit fundamentals specifically related to managed care and government programs audits (CMS/HHS/DOI/Medicaid/Marketplace and Medicare)Exceptional project management skills with a proven ability to lead complex audits and organizational initiatives in a matrixed environmentDemonstrated strategic management and leadership skills, including decision-making and time management for audit facilitation and compliance adherenceIntermediate-level proficiency in Microsoft Word, Excel, and PowerPoint to support audit deliverables and reportingAbility to work independently and within a matrixed environment Attention to detail and strong communication skills necessary Demonstrated critical listening and thinking skills Licensure and Certification: CHA, CHPC, CHCA, CPHQ or other similar certification preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of timeMay be required to work additional hours and/or outside normal business hours as needed to meet deadlines. Remote Position Travel is not typically required $135,600.00 - $237,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Salary Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.