Healthcare Services Operations Support Auditor - Molina Healthcare : Job Details

JOB DESCRIPTIONJob SummaryProvides 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.Essential Job Duties- 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).- 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.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/VPay Range: $24 - $56.17 / HOURLY*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.