Senior Auditor, Delegation Oversight (Remote)

Job description

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 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...