Sr. Auditor, Delegation Oversight (Pharmacy) - REMOTE

Job Description

Job Summary

The 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, Mandatory Employee Trainings and Financial Reviews) of Molina Health Plan, NCQA, CMS and State Medicaid entities.

Job Duties

• Leads and performs pre-delegation, annual audits, ensuring all components of audit activities comply with with NCQA, State and Federal requirements
• 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.
• Prepares, tracks and provides audit finding 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.
• Complete all mandatory compliance training annually or as required by leadership.

Job Qualifications

REQUIRED EDUCATION: Bachelor’s Degree or equivalent, combination of education and experience

REQUIRED 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.