Auditor, Healthcare Services Operations Support

JOB DESCRIPTION 

Job Summary

Provides support for clinical healthcare services auditing activities. Responsible for performing audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. 


Essential Job Duties

• Performs audits of clinical staff in utilization management, care management, member assessment, and/or other teams - monitoring for compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state and federal guidelines and requirements. 

• Reports outcomes, identifies areas of re-training for staff, and communicates findings to leadership. 

• Ensures auditing approaches follow a Molina standard in approach and tool use. 

• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 

• Demonstrates professionalism in all communications. 

• Adheres to departmental standards, policies, protocols. 

• Maintains detailed records of auditing results. 

• Assists healthcare services with developing training materials or job aids as needed to address findings in audit results. 

• Meets minimum production standards related to non-clinical auditing. 

• May conduct staff trainings as needed. 

• Communicates with quality, and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct. 


 Required Qualifications

• At least 2 years health care experience, preferably in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience. 

• Strong analytical and problem-solving skills. 

• Ability to work in a cross-functional, professional environment. 

• Ability to work on a team and independently. 

• Excellent verbal and written communication skills. 

• Microsoft Office suite/applicable software program(s) proficiency. 


 Preferred Qualifications

• Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) non-clinical review/auditing experience


• Root cause analysis


• License in social worker or other behavior health specialty 
  
  
  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