Senior Auditor, Delegation Oversight

JOB DESCRIPTION Job Summary Provides senior level audit support for delegation oversight activities. Responsible for ensuring delegates are complaint 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 Molinau2019s risk. Essential Job Duties u2022 Leads and performs pre-delegation, annual audits, and ensures all components of audit activities comply with contractual, regulatory, and accreditation requirements. u2022 Conducts detailed and focused audits on delegatesu2019 policies, procedures, case files and evidence of ongoing monitoring to ensure quality and cost-effective provision of delegated services. u2022 Engages delegate leadership to educate, collaborate, and/or remediate risks to Molina. u2022 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. u2022 Conducts analysis of audit issues to identify root-causes, develops and issues corrective action plans (CAPs), and documents follow-up to ensure successful remediation. u2022 Prepares, tracks and provides audit finding reports in accordance with departmental requirements. u2022 Prepares, submits and presents audit reports to delegation oversight committees. u2022 Presents audit findings to delegates, and makes recommendations for improvements based on audit results. u2022 Collaborates with delegation oversight leadership to develop and maintain assessment tools. u2022 Makes independent decisions on complex issues and project components. u2022 Serves as subject matter expert on policies, regulations, contractual requirements and delegate contracts for the relevant area. u2022 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. u2022 Conducts outreach to multiple department heads regarding key performance indicator (KPI) data analysis for quarterly meetings. u2022 Provides training and support to new and existing delegation oversight team members. Required Qualifications u2022 At least 3 years of managed care experience, including at least 2 years of delegation oversight auditing experience, or equivalent combination of relevant education and experience. experience. u2022 Ability to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required. u2022 Ability to collaborate cross-functionally across a highly matrixed organization. u2022 Strong attention to detail and organizational skills. u2022 Strong critical-thinking, and problem-solving/analytical abilities. u2022 Strong interpersonal and verbal/written communication skills. u2022 Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs. Preferred Qualifications u2022 Certified Credentialing Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical Coder (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in Healthcare Management (CPHM) and/or other health care certification/licensure. If licensed, license must be active and unrestricted in state of practice. 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 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-12-18