Health Plan Compliance Auditor

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

The Associate, Delegation Compliance supports compliance activities for Oak Street Health's internal care management and utilization management teams. They partner with operational leadership to implement and monitor ongoing quality improvement activities, lead external compliance and accreditation survey processes, and leverage program knowledge and analytical skills to effectively coordinate all compliance activities.

• Possesses and demonstrates knowledge of CMS, contractual, accreditation, federal, state, and business requirements for assigned programs, and ensures compliance with program requirements
• Collaborates with leadership to develop, implement, and maintain policies and procedures for assigned programs
• Collaborates with leadership to develop and execute auditing and monitoring tools utilized for staff and program audits
• Collaborates with payers, serves as SME for compliance-related activities
• Contributes to reports used by internal and external leadership
• Provides input and valuable feedback on auditing results, trends and improvement activities
• Recommends process improvement, interventions, and assists with implementation
• Develops and revises training materials based on QA results
• Analyzes processes and key performance indicators to assess compliance risk, internal control, and overall effectiveness and efficiency
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practices
• Develops Corrective Action Plans (CAPs) and Performance Improvement Plans (PIPs) and is accountable for the adequacy of operational responses and ongoing monitoring
• Performs other job duties, as assigned.

• Bachelor's degree in Healthcare Administration, Compliance, related field, or equivalent experience
• 1-2 years of compliance experience dealing with care management requirements, utilization management requirements, auditing, reporting processes, action plans, and compliance training preferred
• Strong understanding of healthcare laws, NCQA requirements, and Medicare Part C regulatory compliance in a managed care organization or hospital health care system setting
• Experience working with regulators on compliance audits
• Ability to work independently and with others
• Experience in building and supporting strong teamwork and collaborative communication
• Ability to work under pressure with multiple deadlines and priorities
• Strong problem-solving skills, critical thinking skills, and organizational skills
• US work authorization
• Someone who embodies "Being Oaky"

• Radiating positive energy
• Assuming good intentions
• Creating an unmatched patient experience
• Driving clinical excellence
• Taking ownership and delivering results
• Being relentlessly determined

• Mission-focused career impacting change and measurably improving health outcomes for Medicare patients
• Paid vacation, sick time, and investment/retirement 401K match options
• Health insurance, vision, and dental benefits
• Opportunities for leadership development and continuing education stipends
• New centers and flexible work environments
• Opportunities for high levels of responsibility and rapid advancement Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply. Learn more at

40

Full time

The typical pay range for this role is:

$43,888.00 - $93,574.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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