Alignment Health

Auditor, Delegate UM/CM

AuditorAuditorFull TimeRemoteSeniorTeam 501-1,000Since 2013H1B No SponsorCompany Site LinkedIn

Location

United States

Posted

35 days ago

Salary

$77.9K - $116.9K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

• Conduct UM/CM audits in accordance with regulatory, contractual, and industry standards • Execute Utilization Management (UM) and Case Management (CM) audits using established methodologies, sampling criteria, and documentation standards to ensure accuracy, consistency, and regulatory readiness. • Evaluate delegated entities’ compliance with CMS and contractual requirements, and Alignment Healthcare’s UM/CM policies and standards. • Maintain organized, complete, and audit‑ready documentation to support regulatory, accreditation, and internal oversight reviews.

Job Requirements

3-5 years of Utilization and Case Management experience in an HMO, Medicare Advantage, and/or IPA setting, with in-depth knowledge of clinical operations of managed care operations.
Prior Medicare Managed Care UM/CM experience related to delegation oversight and auditing.
1-2 years minimum experience conducting oversight audits of delegated entities and/or ancillary providers.
Demonstrable detailed knowledge/experience with CMS, HICE, or related UM/CM requirements.
Required: Bachelor’s Degree in nursing or equivalent.
Preferred: Master’s degree in nursing or related fields (e.g., MHA, MPH, MBA, MSN).

Benefits

Health insurance
401(k) matching

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