The SDAG Lead oversees audit activities related to Service Determination Requests, Appeals, and Grievances. This position ensures CMS requirements are consistently evaluated and documented while providing technical leadership to audit team members throughout the audit lifecycle.

The position may be filled by either a clinical (RN) or non-clinical professional with specialized CMS PACE audit experience.

Key Responsibilities

• Lead CMS PACE SDAG audit activities.
• Evaluate compliance with CMS requirements governing service determinations, appeals, and grievances.
• Review clinical and administrative documentation supporting determinations.
• Coordinate interviews and document reviews.
• Lead development of audit findings and recommendations.
• Review audit workpapers for quality and consistency.
• Provide technical guidance to auditors.
• Collaborate with CMS staff and project leadership.
• Support corrective action plan reviews.
• Ensure timely completion of assigned deliverables.

Required Qualifications

• Active RN license (clinical candidates only).
• Bachelor's degree or equivalent experience.
• Completion of PACE 2026 CMS Auditor Training.
• Participation in at least two (2) CMS PACE audits during 2026.
• Minimum five years of healthcare compliance, utilization management, appeals, grievances, case management, or audit experience.
• Knowledge of Medicare regulations and CMS audit protocols.
• Strong analytical and written communication skills.

Preferred Qualifications

• Prior CMS MOEG audit experience.
• Experience with Medicare Parts C and D oversight activities.
• Previous audit team leadership.

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 Opportunity

Verve, 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.