Job Overview
Location
Anywhere in the U.S.
Job Type
Full-time
Category
HR & Recruiting
Date Posted
April 10, 2026
Full Job Description
đź“‹ Description
- • The Remote Auditor, Delegate Utilization/Case Management role is critical to Alignment Healthcare’s mission of transforming senior care by ensuring delegated providers meet rigorous regulatory, contractual, and operational standards through Utilization Management (UM) and Case Management (CM) audits.
- • Day to day, the Auditor conducts risk-based UM/CM audits, evaluates compliance with CMS and contractual requirements, maintains audit-ready documentation, communicates findings to delegated provider organizations, validates corrective action plans, and supports organizational awareness through reporting and cross-functional collaboration.
- • Alignment Healthcare is a fast-growing, mission-driven organization committed to serving seniors and the chronically ill, built on a team of passionate professionals dedicated to putting the senior first and transforming lives through innovative, compassionate care.
- • In this role, the Auditor will develop deep expertise in Medicare Advantage oversight, strengthen audit and analytical skills, contribute to data-driven quality improvement, and gain exposure to enterprise-level compliance and performance improvement initiatives.
🎯 Requirements
- • 3-5 years of Utilization and Case Management experience in an HMO, Medicare Advantage, and/or IPA setting with in-depth knowledge of managed care clinical operations.
- • Prior Medicare Managed Care UM/CM experience related to delegation oversight and auditing.
- • Active, unrestricted State License for Licensed Vocational Nurse (LVN) or Registered Nurse (RN).
- • Bachelor’s Degree in nursing or equivalent (Master’s degree preferred).
- • Strong knowledge of Medicare audit processes and applicable state and federal regulatory requirements governing UM/CM.
- • Advanced proficiency with Microsoft Office applications, especially Excel, Word, PowerPoint, and Outlook.
🏖️ Benefits
- • Opportunity to work remotely from anywhere in the U.S.
- • Competitive pay range of $77,905.00 - $116,858.00 based on experience and qualifications.
- • Meaningful work that directly impacts senior health outcomes and supports Alignment Healthcare’s mission to put the senior first.
- • Access to professional growth and innovation in a fast-growing, mission-driven healthcare organization.
- • Support for maintaining regulatory readiness and contributing to data-driven oversight models that improve quality and compliance across delegated clinical functions.
Skills & Technologies
About Alignment Healthcare, LLC
Alignment Healthcare is a health insurance company that focuses on providing personalized care for seniors and underserved populations. They operate a value-based care model, aiming to improve health outcomes and reduce costs through integrated care teams, technology, and data analytics. Their services include Medicare Advantage plans, chronic care management, and home-based care. Alignment Healthcare partners with providers and aims to deliver a seamless and high-quality healthcare experience for its members, emphasizing proactive and preventive care to keep individuals healthy and out of the hospital.
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