Director, Audits (Healthcare)

Accountabilities

Lead healthcare audit operations: Provide strategic and operational leadership for Performance Measure Validation (PMV) and HEDIS® audit activities, ensuring effective execution across multiple projects within the Medicaid services portfolio.
Oversee project delivery: Direct project planning, implementation, monitoring, and reporting across scope, staffing, schedules, budgets, and deliverables. Coordinate multiple large-scale initiatives simultaneously while maintaining high standards of accuracy and efficiency.
Manage and develop teams: Lead, mentor, and coach auditors and multidisciplinary analytical teams. Establish clear expectations, monitor performance, conduct evaluations, encourage professional development, and foster a culture of accountability and collaboration.
Maintain quality and compliance: Ensure all client deliverables undergo appropriate internal review and approval before submission. Conduct Internal Quality Control (IQC) monitoring, identify process inefficiencies, recommend corrective actions, and implement continuous improvement initiatives.
Build client and stakeholder relationships: Serve as a primary liaison with state Medicaid agencies and other partner organizations. Lead client meetings and teleconferences, communicate project progress, present findings, and translate complex analytical results into clear, actionable insights for nontechnical audiences.
Manage financial performance: Oversee staffing plans, labor utilization, project budgets, cost estimates, and financial forecasts in collaboration with finance teams and executive leadership. Identify financial variances and implement appropriate mitigation strategies.
Support contracts and business development: Contribute to requests for proposals (RFPs), cost proposals, contract development, contract reviews, scopes of work, and budgeting activities to support new and existing business opportunities.
Establish effective audit methodologies: Define appropriate audit approaches, coordinate analytical outputs across collaborating teams, and ensure compliance with project schedules, contractual requirements, and established quality standards.
Manage operational risks: Identify and address potential contractual, staffing, financial, operational, and client-related risks, escalating significant concerns to senior leadership when necessary.
Optimize processes and technology: Leverage tools such as Microsoft SharePoint and Copilot to streamline workflows, improve documentation, and enhance the efficiency and consistency of deliverable production.
Promote organizational excellence: Develop and deliver structured training programs for junior and senior staff, contribute to workforce development, and represent the organization professionally in all client and stakeholder interactions.
Requirements
A bachelor's degree or equivalent professional experience in Medicaid managed care, HEDIS, healthcare performance measurement, auditing, or a closely related field.
At least 15 years of professional experience, including a minimum of 10 years in healthcare, preferably within Medicaid programs, managed care, health plan operations, or healthcare quality measurement.
Certification as an NCQA Certified HEDIS Compliance Auditor (CHCA) or demonstrated proficiency in HEDIS reporting and audit methodologies.
Extensive knowledge of Medicaid programs, managed care operations, health plan performance measures, and healthcare auditing practices.
Demonstrated experience evaluating medical and prescription drug claims and encounter data, eligibility and enrollment records, demographic information, survey data, and vital statistics. Experience evaluating electronic health records and clinical data is preferred.
Proven leadership experience managing multiple large-scale projects and supervising multidisciplinary analytical or audit teams, including responsibility for performance monitoring, staff development, and mentoring.
Strong expertise in project planning, resource allocation, budget management, financial forecasting, and cost proposal development, including leading the preparation of cost proposals.
Experience in contract development and review, including the ability to evaluate contractual language, define scopes of work, and support budget negotiations or planning.
Excellent written and verbal communication skills, including strong proofreading, editing, business writing, presentation, and public speaking abilities.
Strong interpersonal skills and the ability to build effective relationships with clients, executive stakeholders, state agencies, and cross-functional teams.
Proficiency in Microsoft Word, PowerPoint, Excel, Outlook, and Copilot, with the ability to use technology to improve project management, reporting, and analytical workflows.
Exceptional organizational, analytical, and problem-solving skills, with the ability to prioritize competing demands, manage several projects concurrently, and deliver accurate results within established deadlines.
Benefits
Competitive annual salary: A base salary range of $133,000 to $160,000, depending on qualifications, experience, and role-related factors.
Fully remote work: The flexibility to work remotely within the United States.
Work-life balance: Flexible work schedules designed to support personal well-being and professional effectiveness.
Generous paid time off: Three weeks of paid time off annually, plus 13 company-paid holidays. Employees also finish work two hours early before each holiday to enjoy additional personal time.
Comprehensive healthcare coverage: Medical, dental, and vision insurance options.
Retirement and ownership opportunities: Access to a 401(k) retirement savings plan and an employee stock ownership plan.
Education assistance: Tuition reimbursement to support ongoing learning and professional development.
Leadership development: Opportunities to grow as a senior healthcare leader, mentor emerging professionals, and help shape organizational quality improvement strategies.
Meaningful professional impact: The opportunity to improve healthcare quality, strengthen the reliability of performance measurement, and support better outcomes for Medicaid beneficiaries and healthcare communities.
Collaborative environment: Work alongside experienced healthcare, audit, analytics, and quality improvement professionals on high-impact initiatives.