Medicare Compliance Internal & Regulatory Auditor presso Clever Care Health Plan

Description

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.  

Who Are We? ✨ 

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. 

Why Join Us? 🏆

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. 

Job Summary

Under the general direction of the Supervisor, Enterprise Compliance, with added guidance from the Compliance Officer, the Internal Auditor prepares and conducts audits of assigned areas pursuant to the internal audit plan.  The Internal Auditor identifies areas of non-adherence with regulatory requirements, develops audit recommendations, and drafts written reports.  The Internal Auditor prepared detailed work papers in accordance with department standards and supports regulatory audits from CMS and state agencies.  The Internal Auditor participates in special reviews as necessary.

Functions & Job Responsibilities

• Utilize CMS regulations from the Federal Registry and the Final Rules to identify priority areas to audit internal departments and related entities and develop work papers
• Prepare audit programs and conduct audits of assigned areas, including performing various audit procedures and documenting findings in work papers
• Identify areas of regulatory non-compliance, develop audit recommendations and draft written reports
• Provide independent evaluations of operational and financial controls, policies, and procedures
• Prepare work papers, observations reports and related documents following department standards
• Perform and coordinate follow-up audits to determine if management has taken action to mitigate risks identified and to close corrective action plans
• Participate in special reviews as necessary
• Perform other duties as assigned

Qualifications

Leadership Expectations

By way of leadership approach, mobilize others to create extraordinary results, and unite people to turn challenges into successes by championing the following:

1. Model the Way:

• Clarify values by finding your voice and affirming shared values
• Set the example by aligning actions with shared values

2. Inspire a Shared Vision

• Envision the future by imagining exciting and ennobling possibilities
• Enlist others in a common vision by appealing to shared aspirations

3. Challenge the Process

• Search for opportunities by seizing the initiative and looking outward for innovative ways to improve
• Experiment and take risks by consistently generating small wins and learning from experience

4. Enable Others to Act

• Foster collaboration by building trust and facilitating relationships
• Strengthen others by increasing self-determination and developing competence

5. Encourage the Heart

• Recognize contributions by showing appreciation for individual excellence
• Celebrate the values and victories by creating a spirit of community
   

Required Qualifications

• At least 2 to 4 years of public or private audit experience, preferably in health care or other highly regulated industry.
• Knowledge of Medicare Advantage, CMS regulations, DMHC regulations, Knox Keene, and internal control principles.
• Excellent MS Office skills (Word, Excel, PowerPoint)

Preferred Qualifications

• Clinical audit experience preferred.

Wage Range:  $70,000/year to $75,000/year

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required  
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

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