Senior Manager, Quality Audit

Summary

Join Included Health as the Senior Manager of Quality Audit, leading the centralized audit function to ensure client audits of care and services meet high standards. You will drive the strategy and execution of the Quality Audit Program, overseeing continuous readiness, real-time audit coordination, and post-audit activities. This role reports to the Director of Operations Performance and involves managing a team of Quality Audit Specialists.

Requirements

• Bachelors Degree
• 3+ years working for a benefit consultancy firm OR, 3+ years working in healthcare or healthcare adjacent internal audit readiness
• 5+ years project management experience - specifically managing cross functional projects
• 5+ years leadership experiencing managing project managers and/or audit consultants
• 2+ experience working with healthcare data and/or quality metrics
• Ability to lead and engage teams through high pressure situations
• Appetite for technology, standardization and leveraging automation, where possible
• Strong written and verbal communication with experience presenting to internal leadership and (desired) external clients/stakeholders
• Strong ability to lead through influence and secure cross-functional commitments to deliver key items on the audit roadmap
• Ability to travel 15%
• Ability to remain seated in a stationary position for prolonged periods
• Requires eye-hand coordination and manual dexterity sufficient to operate keyboard, computer and other office-related equipment
• No heavy lifting is expected, though occasional exertion of about 20 lbs. of force (e.g., lifting a computer / laptop) may be required
• Ability to interact with leadership, employees, and members in an appropriate manner

Responsibilities

• Maintain a deep knowledge of customer contracts, performance guarantees and current risk
• Regularly “test the system” for audit readiness to proactively identify gaps
• Ensure organization is knowledgeable on audit evaluation criteria and partner with training, product, operational teams and clinical teams to ensure readiness to meet audit criteria
• Coordination with training, clinical operations and quality and operational leadership to train on knowledge gaps identified through tracers
• Drive toward automation for Included Health’s “standard” audits
• Ensure our audit methodology is compliant
• Drive creation of materials utilized in audits- both internal and customer-facing
• Create audit plan, which will include roles and responsibilities, timeline, tasks, risks, issues and goals
• Schedule and run internal meetings associated with an audit
• Pull relevant audit data as defined by audit requirements (e.g. calls, chats, cases, etc.)
• If onsite, coordinate catering and customer transportation
• Send leadership/executive status updates leading up to and during audit
• Orchestrate meetings with external auditors- prepare agendas, coach speakers, etc
• Manage remediation plan, pulling in appropriate stakeholders, prioritizing findings and holding team accountable to tasks and timelines
• Document audit findings in an executive summary which will include recommendations for operational, clinical, product and technology teams
• Support Client Success Executive in post-audit activities
• Regular communication with Senior Leadership on audit status and project plans
• Oversee Quality Audit Specialist (s) to execute on day to day program activities
• Responsible for the career development of Quality Audit Specialist team

Benefits

• Remote-first culture
• 401(k) savings plan through Fidelity
• Comprehensive medical, vision, and dental coverage through multiple medical plan options (including disability insurance)
• Full suite of Included Health telemedicine (e.g. behavioral health, urgent care, etc.) and health care navigation products and services offered at no cost for employees and dependents
• Generous Paid Time Off (“PTO”) and Discretionary Time Off (“DTO”)
• 12 weeks of 100% Paid Parental leave
• Family Building Benefit with fertility coverage and up to $25,000 for Surrogacy & Adoption financial assistance
• Compassionate Leave (paid leave for employees who experience a failed pregnancy, surrogacy, adoption or fertility treatment)
• 11 Holidays Paid with one Floating Paid Holiday
• Work-From-Home reimbursement to support team collaboration and effective home office work
• 24 hours of Paid Volunteer Time Off (“VTO”) Per Year to Volunteer with Charitable Organizations