Nextphase Health Solutions

Join our remote federal oversight team to lead and execute compliance audits for the Programs of All-Inclusive Care for the Elderly (PACE). We are actively recruiting qualified compliance and clinical leaders to fill three specialized leadership roles for the upcoming audit cycle.

Overview & Work Arrangement

Primarily part-time; 100% Remote (must reside and perform all work within one of the 50 United States).

Available Positions & Role-Specific Requirements

1. PACE Audit Lead [Non-Clinical or Clinical (RN)]

• Directs the full end-to-end audit lifecycle, coordinating planning, staffing, schedules, and conferences across multidisciplinary teams while integrating cross-element findings and overseeing root cause analyses.
• Licensure: Active Registered Nurse (RN) with unrestricted licensure required if applying as a clinical professional.
• Requirements: Demonstrated experience planning, coordinating, and leading CMS PACE program audits and review activities; comprehensive knowledge of CMS PACE regulations, guidance, and audit protocols; skilled in developing audit reports, corrective action recommendations, and communicating results directly to CMS and PACE organizations.

2. Service Delivery, Access, and Grievances (SDAG) Lead [Non-Clinical or Clinical (RN)]

• Directs the compliance evaluation of participant requests, service delivery workflows, appeals, and grievances to ensure adherence to federal timeframes, required notices, and participant protections.
• Licensure: Active Registered Nurse (RN) with unrestricted licensure required if applying as a clinical professional.
• Requirements: Demonstrated expertise in CMS PACE SDAG audit protocols; thorough understanding of service delivery requirements, appeals, and grievance processes; experience reviewing case documentation, validating evidence, and evaluating workflows for CMS compliance.

3. Provision of Services Lead [Clinical (RN)]

• Directs the clinical review element, evaluating whether required services were authorized, coordinated, and delivered in accordance with participant needs and federal program requirements.
• Licensure: Active Registered Nurse (RN) with unrestricted licensure required.
• Requirements: Extensive clinical knowledge of PACE interdisciplinary care delivery and participant assessment requirements; hands-on experience evaluating clinical records, care planning, service authorizations, quality of care standards, and clinical evidence to substantiate findings.

Mandatory Qualifications

• Auditor Training: Successfully completed the CMS PACE 2026 auditor training.
• Audit Experience: Verified participation in a minimum of two (2) CMS PACE audits during the 2026 audit cycle.
• Experience: At least 2 years of relevant healthcare compliance, auditing, or clinical oversight experience.
• Core Skills: Strong analytical, project management, and written communication skills to evaluate data, synthesize evidence, and produce defensible audit documentation.