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. Role description: 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. Responsibilities: ● 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. What we’re looking for: ● 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” What does being Oaky look like? ● Radiating positive energy ● Assuming good intentions ● Creating an unmatched patient experience ● Driving clinical excellence ● Taking ownership and delivering results ● Being relentlessly determined Why Oak Street Health? Oak Street Health is on a mission to rebuild healthcare as it should be, providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient communities, and focused on the quality of care over volume of services. We are an organization on the move! With over 200+ locations and an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oaky values and passion for our mission. Oak Street Health Benefits: ●