Description:
The Provision of Services Lead provides clinical leadership for CMS PACE audits evaluating the delivery, coordination, and documentation of participant services. This position applies advanced clinical judgment to assess compliance with CMS requirements and supports consistent application of audit protocols across the audit team.
Key Responsibilities
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Lead clinical audit activities involving provision of services.
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Review medical records, interdisciplinary team documentation, and care plans.
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Evaluate delivery of participant services for compliance with CMS PACE requirements.
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Assess care coordination and clinical documentation.
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Lead clinical discussions during audit reviews.
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Review and validate audit findings.
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Provide clinical guidance to audit team members.
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Participate in audit planning and report development.
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Review corrective action plans for clinical appropriateness.
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Collaborate with CMS staff, physicians, and interdisciplinary teams.
Requirements:
Required Qualifications
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Active, unrestricted Registered Nurse (RN) license.
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Bachelor of Science in Nursing (BSN).
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Successful completion of PACE 2026 CMS Auditor Training.
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Participation in at least two (2) CMS PACE audits during 2026.
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Minimum five years of clinical nursing experience in one or more of the following:
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Managed Care
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Case Management
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Utilization Management
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Long-Term Care
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Geriatrics
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Experience reviewing clinical documentation and applying CMS requirements.
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Excellent written and verbal communication skills.
Preferred Qualifications
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Previous CMS PACE audit experience.
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Certified Case Manager (CCM).
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Knowledge of CMS audit protocols and HPMS.
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Experience supporting federal government healthcare contracts.
Why Join Verve?At Verve, you'll work alongside experienced healthcare professionals supporting mission-critical federal healthcare programs that improve quality, compliance, and patient outcomes. We value integrity, collaboration, continuous learning, and professional growth while providing meaningful opportunities to contribute to the success of our government clients.Equal Employment OpportunityVerve, LLC is an Equal Opportunity Employer. We are committed to creating an inclusive workplace and consider all qualified applicants without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other status protected by applicable federal, state, or local law.
