We are seeking a Delegated Network Audit Manager to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Delegated Network Audit Manager is responsible for coordinating audit, compliance, and governance activities across ILS's delegated network operations, with an initial focus on delegated credentialing oversight and audit readiness. This role serves as the primary liaison for delegated network compliance efforts, partnering with internal stakeholders and delegated providers to support audit preparation, compliance monitoring, corrective action planning, remediation tracking, and governance reporting. The position plays a key role in supporting the Quality Improvement and Health Equity Program by maintaining audit readiness, ensuring regulatory compliance, and identifying opportunities to strengthen delegated network oversight. While the role does not directly perform credentialing or provider enrollment functions, it works closely with operational teams to ensure delegated activities remain compliant, consistent, and accountable, with the potential to evolve into broader delegated network governance and operational oversight responsibilities over time.
Minimum Qualifications:
- Bachelor's degree in Healthcare Administration, Business, Administration, Public Health, or a related field, or an equivalent combination of education and relevant experience.
- Minimum of 3 years of experience in healthcare operations, managed care, provider enrollment, credentialing, compliance, audit, or a related healthcare function.
- Experience supporting regulatory compliance, delegated network oversight, payor audits, or compliance monitoring.
- Strong understanding of healthcare operational workflows and compliance standards.
- Excellent analytical, organizational, and communication skills.
- Relevant experience may substitute for educational requirement on a year-for-year basis.
Preferred Qualifications:
- Master's degree in Healthcare Administration, Public Health, or a related discipline.
- Experience with managed care auditing standards or delegation oversight.
- Experience supporting audit programs, governance committees, or organizational compliance initiatives.
- Experience working within a health system or large, multi-entity healthcare organization.
Responsibilities:
- Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
- Lead coordination of delegated network audit readiness, including documentation collection, evidence validation, and audit support for payor reviews, pre-delegation assessments, and compliance evaluations.
- Coordinate audits while maintaining centralized audit documentation, repositories, and supporting materials.
- Monitor delegated network compliance with DHS CalAIM program requirements, internal policies, and service level agreements (SLAs).
- Identify compliance gaps, operational risks, and documentation deficiencies while tracking trends and escalating high-risk concerns as appropriate.
- Partner with operational leaders to develop, monitor, and track corrective action plans (CAPs), remediation activities, and audit follow-up efforts.
- Prepare dashboards, compliance reports, leadership updates, and governance metrics to support organizational oversight and decision-making.
- Assist with the development, maintenance, and continuous improvement of delegated network policies, procedures, crosswalks, and audit readiness documentation.
- Serve as a trusted resource on delegated compliance, governance, and audit readiness while driving continuous process improvement across the delegated network.
- Performs other duties as assigned.