Care Management and Population Health Auditor

Clever Care Health Plan•Huntington Beach, CA

2d•Hybrid

About The Position

Clever Care Health Plan is seeking a Care Management and Population Health Auditor to audit the execution of care management and population health programs. This role is crucial for ensuring compliance with SNP Model of Care requirements, including HRA timeliness, ICP creation/updates, ICT participation, and transitions of care. The auditor will test documentation, data completeness, and outcomes tracking to ensure CMS readiness for internal departments and IPA groups. Clever Care is a rapidly growing Medicare Advantage plan focused on serving diverse communities with innovative benefit plans that blend Western and Eastern medicine.

Requirements

Bachelor’s degree
3–5 years in MA care management/population health auditing
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

Nice To Haves

SNP experience strongly preferred
RN preferred

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.