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, and 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 of 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 work or other behavioral health specialty. Molina Healthcare offers a competitive benefits and compensation package. Pay Range $24 - $46.81 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V #J-18808-Ljbffr
Auditor, Healthcare Services Operations Support (Must reside in Florida) • Doral, FL, United States
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