Auditor, Healthcare Operations

Provides support for non-clinical healthcare services auditing activities. Responsible for performing audits for non-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.

Performs audits of non-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).
• 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.
• Communicates with quality, and / or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve / correct.

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.

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

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V

17 / HOURLY