Sr Manager, Audit Administration

Alignment Health•Lincoln, NE

About The Position

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Senior Manager, Audit Administration, is a key leadership role within Alignment Healthcare’s evolving Delegate Oversight organization. The position is responsible for designing and executing audit strategies that align with organizational risks, regulatory expectations, and strategic objectives. Reporting to the Director of Delegate Oversight & Performance, the Manager plays a central role in transforming the function from a compliance‑focused model to a proactive partner in performance management and improvement. The Manager serves as the primary owner of Alignment’s audit and monitoring program for delegated provider organizations. This includes synthesizing historical audit results, ongoing monitoring data, and subject‑matter insights to develop risk‑based audit strategies across delegated functions such as claims, UM/CM, and credentialing. The Manager leads audit execution, identifies and removes barriers to progress, and prepares clear findings and Corrective Action Plans for leadership and key stakeholders. This role collaborates closely with Delegate Performance, clinical, quality, compliance, and operational teams to ensure audit results translate into actionable expectations, sustainable improvements, and measurable performance outcomes. Success in this position requires strong analytical and problem‑solving skills, deep understanding of delegated models and workflows, and the ability to plan, execute, and influence through effective audit practices.

Requirements

6+ years of experience in healthcare operations, delegated oversight, provider performance management, or value-based care environments.
3+ years of delegated entity oversight, process improvement, compliance, audit management, internal audit or related functions.
Demonstrated ability to design audit plans, implement or enhance audit tools, optimize audit workflows, and improve productivity and output quality.
Strong understanding of delegated functions, including claims, UM, CM/CCM, appeals, and credentialing.
Strong knowledge of managed care principles, delivery systems, medical management processes, accreditation and regulatory standards, and delegated oversight workflows.
Knowledge of managed care compliance requirements, CMS regulatory standards, and NCQA standards.
Experience collaborating cross‑functionally in matrixed healthcare organizations.
Bachelor’s degree required in Healthcare Administration, Public Health, Business Administration, Nursing, or a related field.
Strong organizational and critical‑thinking skills with the ability to manage multiple priorities and complex workstreams effectively.
Ability to communicate positively, professionally, and effectively; demonstrate leadership; and coach, guide, and collaborate with team members and stakeholders.
Excellent written and verbal communication skills, with the ability to build and maintain constructive relationships with delegated entities.
Advanced reasoning and problem‑solving skills, including the ability to define problems, gather and evaluate data, establish facts, draw valid conclusions, and design and manage appropriate resolutions.
Strong analytical skills with the ability to comprehend, interpret, and analyze statistical and performance reports.

Nice To Haves

Master’s degree preferred (e.g., MHA, MPH, MBA, MSN).
Certified in Healthcare Compliance (CHC), Lean/Six Sigma or other continuous improvement methodologies

Responsibilities

Design Audit and Monitoring Strategy Develop an annual, risk based‑ audit and monitoring strategy for all delegated provider functions, incorporating historical audit results, performance trends, regulatory requirements, and emerging risks.
Integrate inputs from subject matter experts, operational leaders, and monitoring data to ensure audit plans are targeted, evidence based, and aligned with organizational priorities.
Define audit scope, methodologies, sampling frameworks, documentation standards, and evaluation criteria to ensure consistency, objectivity, and regulatory readiness.
Continuously refine audit strategy based on outcomes, new insights, changes in delegation arrangements, and shifts in operational or regulatory environments.
Implement Audit and Monitoring Activities Lead, train, and align auditors and specialists to ensure consistent application of audit methodologies, tools, and strategies.
Develop and manage audit schedules to maximize operational impact, ensuring timely execution across delegated functions.
Review, synthesize, and refine monitoring results, incorporating insights to adjust audit plans and target emerging risks.
Identify and proactively resolve obstacles impacting audit progress, maintaining audit integrity, quality, and adherence to timelines.
Maintain organized, accurate, and audit-ready documentation to support regulatory reviews, accreditation audits, and internal oversight requirements.
Cross-Functional Collaboration & Integration Partner with Delegate Performance, clinical operations, quality, compliance and other internal teams to align audit expectations with operational goals and performance initiatives.
Facilitate cross functional‑ discussions to ensure audit results are translated into actionable improvements for delegated entities.
Serve as a trusted advisor to internal teams by providing insights on delegation risks, performance trends, and opportunities to improve oversight effectiveness.
Support integration of audit findings into broader enterprise activities such as provider performance management, quality initiatives, workflows, and risk mitigation plans.
Reporting, Insights & Continuous Improvement Develop clear, concise, and executive‑ready audit reports, dashboards, and summaries that highlight key risks, patterns, and performance trends across delegated entities.
Deliver audit results to leadership and stakeholders in a manner that promotes understanding, ownership, and action.
Identify systemic issues and recurring trends, recommending process improvements or oversight enhancements to strengthen compliance and operational performance.
Maintain accurate, organized audit documentation and records to support regulatory, accreditation, and internal review requirements.
Drive continuous improvement of the audit program through updated tools, refined methodologies, enhanced analytics, and feedback from stakeholders.