Compliance Auditor, MAPD

Support compliance excellence at UCLA Health by joining our team as a Compliance
Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug
(Part D) programs. In this vital role, you will conduct compliance risk-based
audits, support external audit coordination, and ensure alignment with CMS and
DMHC regulations across the organization.

Reporting to the Compliance Manager, MAPD Audit, you will
contribute to the organization's audit work plan, assess operational risk
areas, and prepare audit findings that help guide regulatory readiness and
operational improvement. This position calls for a strong foundation in CMS
guidelines, managed care compliance, and effective collaboration with both
internal teams and external partners.

In this role, you will:

• Conduct
  compliance audits related to operational functions, vendor performance,
  data validation, RADV, Triennial Review, pre-delegation reviews, and more.
• Design
  and improve audit toolkits based on Medicare Advantage and Part D risk
  areas.
• Collaborate
  with stakeholders and leadership to identify and address compliance risks.
• Maintain
  comprehensive documentation of audit activities and findings.
• Prepare
  detailed and professional audit reports for senior leadership and
  regulatory bodies.
• Support
  organization-wide audit readiness and regulatory preparedness.
• Coordinate
  external audits and ensure timely responses to agencies such as CMS or
  DMHC.
• Assist
  in training internal teams on compliance auditing procedures and best
  practices.
• Track
  and report compliance metrics, risk trends, and audit performance
  indicators.

Salary Range: $83,800 - $179,400 annually

We're seeking a compliance professional with:

• Bachelor's degree in business administration, healthcare,
  or a related field and/or equivalent experience.
• 5 or more years of experience in Medicare Advantage or Part
  D Managed Care environment
• Strong understanding of CMS audit protocols, expectations,
  and regulations.
• Experience participating in audits conducted by CMS and/or
  DMHC.
• Ability to interpret and operationalize complex compliance
  guidance.
• Excellent oral and written communication skills.
• Strong critical thinking and analytical abilities.
• Ability to lead or support compliance projects with minimal
  supervision.
• Proven track record of preparing professional,
  data-informed audit reports.
• Ability to work collaboratively across departments and
  functions in a fast-paced environment.
• High degree of integrity, attention to detail, and
  commitment to regulatory excellence.