Job DescriptionEmployees for this role will work remotely anywhere in the US.Job SummaryThe Sr Auditor, Delegation Oversight will independently perform audits of multi-delegated functions with minimal oversight and expertise in at least one functional area of auditing. Ensures continuous compliance with Program Integrity requirements (e.g., Monitoring of Exclusion Databases, and Mandatory Employee Trainings) of Molina Health Plan, NCQA, CMS and State Medicaid entities.Job Duties
Oversees Utilization Management, Claims, Organizational Credentialing, and Crisis Call Center delegated activities.
Leads and performs pre-delegation, annual audits, ensuring all components of audit activities comply with NCQA, State and Federal requirements
Lead external collaborative with other agencies in providing oversight of Behavioral Health Administrative Service Organization for monitoring and auditing of Crisis Lines, Utilization Management, and Organizational Credentialing.
Ensure that all external partners in the collaborative are assigned to BHASO audits and are completing audits timely.
Conducts focused audits on subcontractors, as applicable, documenting the outcomes and making recommendations as necessary for further action.
Conducts analysis of audit issues to identify root cause, develop and issue corrective action plans.
Build and grow internal and external partnerships to continue team approach to delegate support.
Prepares, tracks and provides audit reports in accordance with departmental requirements.
Prepare, submit and present audit reports to Delegation Oversight Committees.
Presents audit findings to subcontractors and makes recommendations for improvements based on audit results.
Works with Delegation Oversight Management to develop and maintain assessment tools.
Update delegates on all Contracting, Federal and State guidelines related to their delegated responsibilities
Complete all mandatory compliance training annually or as required by leadership.
Job QualificationsREQUIRED EDUCATION : Bachelor’s Degree or equivalent, combination of education and experienceREQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :
Minimum three years Delegation Oversight experience.
Minimum two year auditing or utilization review experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Pay Range: $49,430.25 - $107,098.87 / ANNUALActual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
