United States onlyProvidence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Providence Health Plan is calling an Audit and Compliance Analyst who will:
- Handle various elements of program compliance, policy development auditing, monitoring and report development within the Health Care Services teams including Care Management and Utilization Management
- Work as a liaison for external delegated entities to provide operational support in addition to auditing and monitoring delegated functions
- Work with the Regulatory Compliance & Government Affairs department (RCGA) to evaluate state and federal regulations as they apply to Health Care Services and the various lines of business
- Work closely with the Clinical Analytics and Information Systems teams to develop, review and validate internal and external audit reports
- Assist teams with the review and interpretation of regulatory guidance and requirements as well as policy and procedure development
- Work closely with business partners and delegates, providing monitoring and oversight of their activities as they relate to Providence Health Plans to ensure they are compliant with all regulatory requirements, accreditation standards for the National Committee for Quality Assurance (NCQA) and meeting all client Service Level Agreements (SLA's)
We welcome 100% remote work for residents who reside in one of the following States / Region of Residency:
- Oregon
- Washington
- California
Required qualifications for this position include:
- Bachelor's Degree in Business Administration, Healthcare Administration, or another related field of study -OR- a combination of equivalent education and experience
- 3+ years' experience working with administrative, policy and / or operational aspects of managed care
- 3+ years' experience in project management
- 3+ years' experience in data analysis
- 3+ years' experience in procedure development
- 1+ years' experience in technical or operational policy and procedure writing as it relates to regulatory requirements and accreditation standards
- Experience with managed care regulatory compliance matters in one or more of the following lines of business: Medicare, Medicaid, Commercial
- Experience assessing program compliance and establishing auditing and monitoring protocols
Preferred qualifications for this position include:
- Experience with CMS and State Medicaid regulations and programs as they relate to Medical Management
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
