Care Management and Population Health Auditor
Clever Care Health Plan, Huntington Beach, CA, United States
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
The Care Management & Population Health Auditor audits the execution of care management and population health programs, including SNP Model of Care requirements: HRA timeliness, ICP creation/updates, ICT participation, and transitions of care; tests documentation, data completeness, and outcomes tracking to ensure CMS readiness for internal departments and IPA groups.
Functions & Job Responsibilities
Conduct scheduled and ad hoc audits of MOC elements (HRA, ICP/ICT, care coordination, TOC) and maintain evidence packages for CMS review.
Perform SNPCC mock studies and file validation; partner with Population Health to close defects and sustain improvements.
Verify alignment with the MA benefit and access framework, collaborating with Clinical teams to resolve gaps that affect basic benefits under 422.101.
Support delegation oversight testing for clinical functions as required by 422.504.
Produce dashboards on HRA timeliness, ICP/ICT completion, and MOC outcome measures for Compliance and the Board.
Qualifications
Required Qualifications
Bachelor’s degree plus 3–5 years in MA care management/population health auditing.
SNP experience strongly preferred.
Working knowledge of SNP MOC operations and evidence requirements.
Understanding of MA clinical benefits standards under 422.101.
Deep knowledge of CMS Program Audit (ODAG, SNP-MOC, SNPCC, CPE).
Deep knowledge of Delegation oversight principles and evidence requirements.
Deep knowledge of Model of Care regulatory structure and operational requirements.
Preferred Qualifications
RN preferred.
SNP experience strongly preferred.
Wage Range:
$80,000 to $90,000
Physical & Working Environment
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 the public. May occasionally be required to work irregular hours based on the needs of the business.
Leadership Expectations
Model the Way: Clarify values by finding your voice and affirming shared values.
Set the example by aligning actions with shared values.
Inspire a Shared Vision: Envision the future by imagining exciting and ennobling possibilities.
Enlist others in a common vision by appealing to shared aspirations.
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.
Enable Others to Act: Foster collaboration by building trust and facilitating relationships.
Strengthen others by increasing self-determination and developing competence.
Encourage the Heart: Recognize contributions by showing appreciation for individual excellence.
Celebrate the values and victories by creating a spirit of community.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affidavitative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
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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
The Care Management & Population Health Auditor audits the execution of care management and population health programs, including SNP Model of Care requirements: HRA timeliness, ICP creation/updates, ICT participation, and transitions of care; tests documentation, data completeness, and outcomes tracking to ensure CMS readiness for internal departments and IPA groups.
Functions & Job Responsibilities
Conduct scheduled and ad hoc audits of MOC elements (HRA, ICP/ICT, care coordination, TOC) and maintain evidence packages for CMS review.
Perform SNPCC mock studies and file validation; partner with Population Health to close defects and sustain improvements.
Verify alignment with the MA benefit and access framework, collaborating with Clinical teams to resolve gaps that affect basic benefits under 422.101.
Support delegation oversight testing for clinical functions as required by 422.504.
Produce dashboards on HRA timeliness, ICP/ICT completion, and MOC outcome measures for Compliance and the Board.
Qualifications
Required Qualifications
Bachelor’s degree plus 3–5 years in MA care management/population health auditing.
SNP experience strongly preferred.
Working knowledge of SNP MOC operations and evidence requirements.
Understanding of MA clinical benefits standards under 422.101.
Deep knowledge of CMS Program Audit (ODAG, SNP-MOC, SNPCC, CPE).
Deep knowledge of Delegation oversight principles and evidence requirements.
Deep knowledge of Model of Care regulatory structure and operational requirements.
Preferred Qualifications
RN preferred.
SNP experience strongly preferred.
Wage Range:
$80,000 to $90,000
Physical & Working Environment
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 the public. May occasionally be required to work irregular hours based on the needs of the business.
Leadership Expectations
Model the Way: Clarify values by finding your voice and affirming shared values.
Set the example by aligning actions with shared values.
Inspire a Shared Vision: Envision the future by imagining exciting and ennobling possibilities.
Enlist others in a common vision by appealing to shared aspirations.
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.
Enable Others to Act: Foster collaboration by building trust and facilitating relationships.
Strengthen others by increasing self-determination and developing competence.
Encourage the Heart: Recognize contributions by showing appreciation for individual excellence.
Celebrate the values and victories by creating a spirit of community.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affidavitative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
#J-18808-Ljbffr