Director, Audits (Healthcare)
New
J
JobgetherHealthcare auditing
Based in the United States; work remotely within the United StatesFull-TimeDirector
Salary133,000 - 160,000 USD per year
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Job Details
- Experience
- At least 15 years of professional experience, including a minimum of 10 years in healthcare
- Required Skills
- Project ManagementMicrosoft ExcelBudget management
Requirements
- Bachelor's degree or equivalent professional experience in Medicaid managed care, HEDIS, healthcare performance measurement, auditing, or a closely related field.
- At least 15 years of professional experience, including a minimum of 10 years in healthcare.
- Experience preferably in Medicaid programs, managed care, health plan operations, or healthcare quality measurement.
- NCQA Certified HEDIS Compliance Auditor (CHCA) certification or demonstrated proficiency in HEDIS reporting and audit methodologies.
- Extensive knowledge of Medicaid programs, managed care operations, health plan performance measures, and healthcare auditing practices.
- Experience evaluating medical and prescription drug claims and encounter data, eligibility and enrollment records, demographic information, survey data, and vital statistics.
- Experience evaluating electronic health records and clinical data is preferred.
- Leadership experience managing multiple large-scale projects and supervising multidisciplinary analytical or audit teams, including staff development and mentoring.
- Expertise in project planning, resource allocation, budget management, financial forecasting, and cost proposal development.
- Experience in contract development and review, evaluating contractual language, defining scopes of work, and supporting budget negotiations or planning.
- Strong written and verbal communication, proofreading, editing, business writing, presentation, and public speaking abilities.
- Proficiency in Microsoft Word, PowerPoint, Excel, Outlook, and Copilot.
Responsibilities
- Lead Performance Measure Validation (PMV) and HEDIS audit activities across multiple projects in the Medicaid services portfolio.
- Direct project planning, implementation, monitoring, and reporting across scope, staffing, schedules, budgets, and deliverables.
- Lead, mentor, coach, and evaluate auditors and multidisciplinary analytical teams.
- Review client deliverables, conduct Internal Quality Control monitoring, and implement corrective actions and continuous improvement initiatives.
- Serve as a primary liaison to state Medicaid agencies and partner organizations; lead meetings, communicate progress, and present findings.
- Oversee staffing plans, labor utilization, project budgets, cost estimates, and financial forecasts.
- Contribute to RFPs, cost proposals, contract development and reviews, scopes of work, and budgeting activities.
- Define audit approaches and coordinate analytical outputs across collaborating teams.
- Identify and address contractual, staffing, financial, operational, and client-related risks.
- Use Microsoft SharePoint and Copilot to streamline workflows, improve documentation, and support deliverable production.
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