Clinical Audit Manager (Remote)
Vida Health, United States

• Prepares team for oversight audits; coordinates end-to-end audits
• Owns final response submission and relationship with auditing/over-sighting body
• Prepares corrective action plans in response to oversight body's request
• Owns and drives execution of the internal audit readiness plan, including prioritization, day-to-day monitoring and report out on progress
• Executes internal risk assessment reviews as part of Audit Readiness Work plans
• Develops and improves departmental processes and operations
• Monitors goals, performance and processes, including compliance with CAP execution and timelines
• Manages the ‘Audit Calendar’ consisting of internal audits, external audits and sub-delegate oversight audits
• Assists with issues of non-compliance
• Facilitates internal Compliance Committee Meetings and processes, working directly with Compliance Officer and Privacy/Security Officer
• Writes policies and procedures and assists with development of provider manuals, audit tools, and guidelines
• Trains new associates and re-trains current associates
• Serves as a resource and a subject matter expert

• BS in nursing, health sciences, health management or a related clinical field required
• BSN, CPHQ (Certified Professional in Healthcare Quality) and prior project management experience is preferred
• 5 years of experience in pop health management, quality assurance and/or regulatory/accreditation standards/audits
• 3 years of quality management experience; or any combination of education and experience
• Experience in both health insurance and provider practice organizations preferred
• Experience in Commercial, Medicare, Medicaid and Duals preferred
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skillsUnderstanding of NCQA, URAC and CMS as well as Medicare and Medicaid audit requirements and processes: Clinical/pop health, HEDIS, Risk adjustment, Claims/Network, Compliance Program
• Experience with facilitating/maintaining NCQA accreditation

• Current active unrestricted license as an RN, LCSW, LMSW, LMHC, LPC, LBA (as allowed by applicable state laws), LMFT, or clinical Psychologist, to practice as a health professional within the scope of licensure in applicable states or territory of the United States required

• Competitive compensation with meaningful stock options
• Medical, Dental, Vision, Disability and Life Insurance (We cover 100% of your premium and 80% for your dependents)
• Healthcare FSA Plan
• Dependent Care FSA Plans
• Commuter and Parking Benefits
• 401K Program
• Flexible PTO Policy
• Paid Parental Leave
• 10 Paid Company Holidays

• We’re a distributed company, so you can work from most US states (We still have a HQ office in San Francisco)
• Access to a Vida Health Coach and the full Vida App
• New hire home office stipend
• Monthly wellness benefit
• Training and leadership development programs
• Weekly meetups with team members across the country through our #connectandcommit program
• Quarterly All Company Events
• Quarterly Team Based Connection Opportunities
• Significant opportunities for growth and development as the business grows

Job Rewards and Benefits