Delegate Improvement Auditor / Analyst

Your tasks

• Develop performance metrics and analytical insights: Design and maintain metrics that evaluate delegated entity performance, quality outcomes, and regulatory compliance. Produce reports and analyses that translate complex data into clear, actionable recommendations.
• Identify trends and improvement opportunities: Analyze performance patterns, emerging risks, and operational gaps across delegated programs. Communicate findings to stakeholders to support informed decision-making and measurable improvements.
• Conduct audits and oversee delegate performance: Complete comprehensive audits based on applicable state and federal requirements. Evaluate performance against contractual obligations, regulatory standards, and quality expectations, documenting findings and recommended actions.
• Drive corrective actions and continuous improvement: Collaborate with internal teams and delegated partners to identify deficiencies, develop improvement strategies, monitor corrective actions, and validate sustained progress.
• Coordinate government audit support: Support preparation for Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) audits, including data validation, report preparation, and documentation collection.
• Manage audit requests and follow-up: Work with delegates and internal stakeholders to provide accurate, timely, and well-supported responses to audit inquiries. Track findings, coordinate resolution activities, and support follow-up efforts.
• Strengthen cross-functional data integration: Partner with clinical, operational, compliance, and analytics teams to align information across reports, submissions, and oversight tools. Investigate discrepancies through root-cause analysis and help maintain data consistency.
• Provide analytical guidance: Serve as a resource for colleagues on performance metrics, reporting standards, analytical methods, and interpretation of results.
• Improve processes and analytical tools: Identify opportunities to enhance reporting workflows, oversight procedures, and analytical tools, recommending changes that improve accuracy, efficiency, and usability.
• Support broader oversight initiatives: Contribute advanced analytical judgment and strategic recommendations to strengthen delegate oversight, program performance, and organizational analytical capabilities.

Requirements

• Bachelor's degree in Nursing, Social Work, Healthcare Administration, or a related field, or equivalent relevant work experience.
• At least five years of professional work experience beyond the degree, or equivalent experience consistent with the role's requirements.
• Strong analytical skills, including the ability to interpret complex data, develop performance metrics, identify trends, and translate findings into practical recommendations.
• Experience evaluating performance against established standards, identifying compliance gaps, documenting findings, and supporting improvement plans.
• Strong written and verbal communication skills, with the ability to present analytical results clearly and collaborate across multiple departments.
• Excellent organizational skills and attention to detail, particularly when managing audit documentation, reporting deadlines, and regulatory requests.
• Ability to work independently with minimal supervision, exercise sound judgment, and manage complex analytical projects.
• Strong collaboration and problem-solving skills, including the ability to investigate discrepancies, determine root causes, and coordinate effective solutions.
• Preferred qualifications:
• Experience in care coordination, care management, or case management, particularly in government healthcare programs.
• Previous audit experience, including preparation for regulatory reviews and follow-up on findings.
• Knowledge of Medicaid and Special Needs Plan (SNP) products.
• Project management or program management experience.
• Proficiency in Microsoft Office applications, particularly Excel, Word, and PowerPoint.
• Remote work eligibility: Must have a primary home address in one of the following states where the employer is registered: Arkansas, Arizona, Florida, Georgia, Iowa, Illinois, Kansas, Kentucky, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Oklahoma, South Dakota, Tennessee, Texas, Virginia, or Wisconsin.
• Work authorization: Must be legally authorized to work in the United States at the time of application. Visa sponsorship is not available for this role, and employment is contingent on verification of identity and work eligibility.

What we offer

• Annual salary: Full salary grade of $70,200–$120,400, with placement based on education, experience, relevant certifications or licensure, role responsibilities, internal pay equity, and external market data.
• Medical coverage: Competitive medical insurance.
• Dental and vision: Dental and vision insurance options.
• Paid time off: PTO and paid holidays.
• Community involvement: Paid volunteer time off.
• Retirement benefits: 401(k) contributions.
• Caregiver support: Access to caregiver services.
• Additional rewards: A broader total rewards package with additional employee benefits.
• Remote flexibility: Fully remote work for candidates who meet the approved-state residency requirements.
• Meaningful contribution: The opportunity to support healthcare quality, regulatory compliance, and continuous improvement across delegated programs.
• Collaborative environment: Work with clinical, operational, compliance, and analytics professionals to improve performance and support coordinated care.

How to apply

How Jobgether works We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether?

Other

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