Compliance & Regulatory Audit Manager

Tyvan LLC

5d•Hybrid

About The Position

The Compliance & Regulatory Audit Manager is responsible for overseeing and supporting regulatory compliance, operational audits, delegated oversight, and healthcare compliance initiatives across the IPA/MSO environment. This position is responsible for managing health plan audits, DMHC audits, pre-delegation (Pre-Del) audits, quality management (QM) audits, policy and procedure compliance, corrective action plans, and ongoing regulatory readiness activities. The role ensures organizational compliance with state, federal, health plan, CMS, NCQA, and delegated managed care requirements while supporting operational excellence and risk mitigation initiatives.

Requirements

Bachelor’s degree in Healthcare Administration, Public Health, Business Administration, Compliance, or a related field required.
3–4 years of healthcare compliance, regulatory audit, or managed care operations experience required.
Experience in an MSO, IPA, medical group, managed care organization, health plan, or delegated healthcare environment.
Experience supporting or managing DMHC audits, Pre-Delegation (Pre-Del) audits, Quality Management (QM) audits, Health plan delegated audits, CMS or NCQA-related compliance activities.
Experience developing, implementing, and monitoring corrective action plans (CAPs).
Experience reviewing healthcare operational policies, procedures, and regulatory requirements.
Experience coordinating document collection and audit readiness activities.
Experience working with Medicare Advantage, Medi-Cal, or delegated managed care programs.
Experience communicating with health plans, auditors, providers, operational departments, and leadership teams.
Knowledge of healthcare regulatory standards, compliance requirements, and delegated oversight processes.
Experience maintaining compliance tracking logs, audit reports, and regulatory documentation.
Strong understanding of healthcare compliance, managed care operations, and delegated healthcare environments.
Strong knowledge of DMHC, CMS, NCQA, Medi-Cal, and Medicare Advantage regulatory requirements.
Knowledge of Pre-Delegation (Pre-Del), Quality Management (QM), and health plan audit processes.
Strong understanding of corrective action plans, audit remediation, and compliance monitoring activities.
Excellent organization, project management, and attention to detail.
Strong analytical, problem-solving, and critical-thinking skills.
Ability to manage multiple audits, projects, and deadlines in a fast-paced healthcare environment.
Excellent written and verbal communication skills.
Proficiency in Microsoft Excel, Outlook, Word, PowerPoint, and compliance reporting systems.
Ability to work independently and collaboratively with operational departments and executive leadership.
Ability to maintain confidentiality and comply with HIPAA and healthcare regulatory requirements.

Nice To Haves

Experience supporting Access & Availability audits.
Experience with credentialing oversight and delegated compliance functions.
Experience with utilization management, quality improvement, or population health compliance programs.
Experience supporting annual regulatory filings and health plan reporting requirements.
Experience with policy and procedure development and implementation.
Experience using healthcare compliance tracking systems or reporting tools.
Experience supporting NCQA accreditation or CMS audit preparation.
Experience with Texas TDI and/or AHCCCS.
Certified in Healthcare Compliance (CHC) preferred.
Certified Professional in Healthcare Quality (CPHQ) preferred.
NCQA or managed care compliance training preferred.
Project Management Professional (PMP) certification preferred.

Responsibilities

Overseeing and supporting regulatory compliance, operational audits, delegated oversight, and healthcare compliance initiatives.
Managing health plan audits, DMHC audits, pre-delegation (Pre-Del) audits, quality management (QM) audits.
Ensuring policy and procedure compliance.
Managing corrective action plans.
Conducting ongoing regulatory readiness activities.
Ensuring organizational compliance with state, federal, health plan, CMS, NCQA, and delegated managed care requirements.
Supporting operational excellence and risk mitigation initiatives.
Supporting Access & Availability audits.
Overseeing credentialing oversight and delegated compliance functions.
Supporting utilization management, quality improvement, or population health compliance programs.
Supporting annual regulatory filings and health plan reporting requirements.
Developing and implementing policies and procedures.
Using healthcare compliance tracking systems or reporting tools.
Supporting NCQA accreditation or CMS audit preparation.
Supporting Texas TDI and/or AHCCCS.
Coordinating document collection and audit readiness activities.
Communicating with health plans, auditors, providers, operational departments, and leadership teams.
Maintaining compliance tracking logs, audit reports, and regulatory documentation.