Top 5368 Cms manager Jobs

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Manager of Compliance Audit

PROVIDER RESOURCES INC -
Remote

Quick Apply

Job Details

Full-time
$105,000 - $155,000 a year

Qualifications

Quality control corrective actions
Quality records maintenance
Process audits
Case assessment
Audit report preparation
5 years
Preventive action implementation
CMS
Healthcare documentation compliance audits
Corrective and preventive actions (CAPA)
Inspection reporting and documentation
Quality control audit
Audit Reporting
CMS regulatory compliance
Quality assurance audits
Medicare regulations
Regulatory readiness in healthcare
Investigating compliance violations
Senior level
Audit support
Analytics

Full Job Description

About the role:

Provider Resources Inc. (PRI) is looking for a Manager of Compliance Audit to own our IDR determination audit function. This is an individual contributor role for a compliance professional with deep IDR and No Surprises Act knowledge who can audit case-level determinations, identify systemic patterns, and drive corrective action in a fast-scaling, CMS-regulated environment.

What you will do:

Audit IDR operational determinations for accuracy, consistency, and CMS regulatory compliance
Identify patterns across reviewers, case types, and program lines and escalate systemic findings
Maintain audit documentation and findings reports to URAC and CMS standards
Track findings through CAPA to resolution
Support external URAC and CMS audit preparation

What we are looking for:

5 to 8 years compliance or auditing experience in a healthcare or regulated environment
Direct knowledge of the IDR process, No Surprises Act, and CMS IDR regulations — IDRE or IRO experience preferred
Experience conducting structured compliance audits and producing findings reports
Analytical — comfortable identifying patterns across large case volumes
URAC or NCQA audit familiarity preferred

Why PRI:

Meaningful work — PRI processes payment disputes that directly protect patients from unexpected medical bills under the No Surprises Act
Growth stage — we are building the systems, processes, and team that will define PRI for the next decade
Skills framework — every role at PRI has a defined skills ontology with clear growth paths and Udemy development pathways
Lean and direct — decisions get made, work is visible, and contributions matter

PRI is an equal opportunity employer. We evaluate candidates on demonstrated skills and capability.

About PROVIDER RESOURCES INC

Join Provider Resources (PRI) and Make an Impact in Healthcare! At PRI, we’re passionate about driving integrity and advancing quality across the healthcare system. As a trusted leader in the industry, we’re tackling some of healthcare’s biggest challenges—improving compliance, advancing health equity, and enhancing quality and clinical outcomes while helping organizations improve care delivery and create meaningful change. We believe that people are at the heart of healthcare, and focus on scalable, person-centered strategies that prioritize clinical excellence and evidence-based practices. Our work supports a broad network of stakeholders, including providers, patients, caregivers, payers, and regulators. We strive to enhance experiences, improve outcomes, and foster a healthier future for all. If you’re looking to be part of a forward-thinking team that makes a difference, PRI is the place for you!

Quick Apply

Refine Your Search

cms manager jobs

Manager of Compliance Audit

Sr. Product Manager

Clinical Pharmacy Manager Solid Organ Transplant

Respiratory Therapy Manager

Clinical Services Manager (MCS)

Manager - Registered Nurse Surgery

MH Quality/Clinical Informatics Program Manager

Registered Nurse (RN) Case Manager | Homecare Rock Rapids

Pharmacy Manager

RN Supervisor

Supervisor Pharmacy

On Site - Coding Manager

Broker Account Manager

Personal Injury Case Managing Supervisor

Business Development Manager

Physical Therapist Manager

Clinical Nurse Manager

RN Supervisor

Home Health and Hospice Clinical Manager

Risk Manager

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