Senior Auditor, Delegation Oversight (Remote)

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    "ExternalDescriptionStr": "<p>JOB DESCRIPTION Job Summary</p>\n<p>Provides senior level audit support for delegation oversight activities. &nbsp;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. &nbsp;Identifies risk and non-compliance, issues corrective action, and actively manages the corrective action process to completion reducing and managing Molina’s risk.</p>\n<p>&nbsp;</p>\n<p><strong>Essential Job Duties</strong></p>\n<p>• Leads and performs pre-delegation, annual audits, and ensures all components of audit activities comply with contractual, regulatory, and accreditation requirements.<br>\n  • 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. &nbsp;<br>\n  • Engages delegate leadership to educate, collaborate, and/or remediate risks to Molina.&nbsp;<br>\n  • 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.&nbsp;<br>\n  • Conducts analysis of audit issues to identify root-causes, develops and issues corrective action plans (CAPs), and documents follow-up to ensure successful remediation.<br>\n  • Prepares, tracks and provides audit finding reports in accordance with departmental requirements.<br>\n  • Prepares, submits and presents audit reports to delegation oversight committees.<br>\n  • Presents audit findings to delegates, and makes recommendations for improvements based on audit results.<br>\n  • Collaborates with delegation oversight leadership to develop and maintain assessment tools.&nbsp;<br>\n  • Makes independent decisions on complex issues and project components.<br>\n  • Serves as subject matter expert on policies, regulations, contractual requirements and delegate contracts for the relevant area.<br>\n  • 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.&nbsp;<br>\n  • Conducts outreach to multiple department heads regarding key performance indicator (KPI) data analysis for quarterly meetings.<br>\n  • Provides training and support to new and existing delegation oversight team members.<br>\n  &nbsp;</p>\n<p><strong>Required Qualifications</strong></p>\n<p>• 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.<br>\n  experience.<br>\n  • Ability to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required.<br>\n  • Ability to collaborate cross-functionally across a highly matrixed organization.<br>\n  • Strong attention to detail and organizational skills.<br>\n  • Strong critical-thinking, and problem-solving/analytical abilities.<br>\n  • Strong interpersonal and verbal/written communication skills. &nbsp;<br>\n  • Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs.<br>\n  &nbsp;</p>\n<p><strong>Preferred Qualifications</strong></p>\n<p>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. &nbsp;If licensed, license must be active and unrestricted in state of practice.<br>\n  &nbsp;</p>\n<p>&nbsp;</p>\n<p>&nbsp;</p>\n<p>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.<br><br>\n  Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p>",
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