Senior Auditor, Delegation Oversight

Job Title

Provides senior level audit support for delegation oversight activities. Responsible for ensuring delegates are compliant with the applicable state, federal, contractual requirements, National Committee for Quality Assurance (NCQA), and Molina requirements for the health plan(s) they support. Identifies risk and non-compliance, issues corrective action, and actively manages the corrective action process to completion reducing and managing Molina's risk.

Essential Job Duties

• Leads and performs pre-delegation, annual audits, and ensures all components of audit activities comply with contractual, regulatory, and accreditation requirements.
• Conducts detailed and focused audits on delegates' policies, procedures, case files and evidence of ongoing monitoring to ensure quality and cost-effective provision of delegated services.
• Engages delegate leadership to educate, collaborate, and / or remediate risks to Molina.
• Leverages highly skilled analytical insights and experience to identify delegate systemic issues and risks that impact the business; collaborates with health plans and / or corporate departments and other business owners to actively address and mitigate risk to Molina.
• Conducts analysis of audit issues to identify root-causes, develops and issues corrective action plans (CAPs), and documents follow-up to ensure successful remediation.
• Prepares, tracks and provides audit finding reports in accordance with departmental requirements.
• Prepares, submits and presents audit reports to delegation oversight committees.
• Presents audit findings to delegates, and makes recommendations for improvements based on audit results.
• Collaborates with delegation oversight leadership to develop and maintain assessment tools.
• Makes independent decisions on complex issues and project components.
• Serves as subject matter expert on policies, regulations, contractual requirements and delegate contracts for the relevant area.
• Remains current on applicable regulatory, contractual and accreditation requirements and standards; interprets regulatory, contractual and accreditation changes and assesses their impact on the relevant area.
• Conducts outreach to multiple department heads regarding key performance indicator (KPI) data analysis for quarterly meetings.
• Provides training and support to new and existing delegation oversight team members.

Required Qualifications

Preferred Qualifications

To all current Molina employees : If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $77,969 - $128,519 / ANNUAL