Molina Healthcare · 1 month ago
Senior Auditor, Delegation Oversight
United States
Full-time
Remote
Mid, Senior Level
$78K/yr - $129K/yr
3+ years expMolina Healthcare is a company focused on managed care, and they are seeking a Senior Auditor for Delegation Oversight. This role involves leading audit activities, ensuring compliance with regulatory and contractual requirements, and managing corrective actions to mitigate risks associated with delegation oversight.
Health CareHospitalMedical
Responsibilities
Leads and performs pre-delegation, annual audits, and ensures all components of audit activities comply with contractual, regulatory, and accreditation requirements
Conducts detailed and focused audits on delegates’ policies, procedures, case files and evidence of ongoing monitoring to ensure quality and cost-effective provision of delegated services
Engages delegate leadership to educate, collaborate, and/or remediate risks to Molina
Leverages highly skilled analytical insights and experience to identify delegate systemic issues and risks that impact the business; collaborates with health plans and/or corporate departments and other business owners to actively address and mitigate risk to Molina
Conducts analysis of audit issues to identify root-causes, develops and issues corrective action plans (CAPs), and documents follow-up to ensure successful remediation
Prepares, tracks and provides audit finding reports in accordance with departmental requirements
Prepares, submits and presents audit reports to delegation oversight committees
Presents audit findings to delegates, and makes recommendations for improvements based on audit results
Collaborates with delegation oversight leadership to develop and maintain assessment tools
Makes independent decisions on complex issues and project components
Serves as subject matter expert on policies, regulations, contractual requirements and delegate contracts for the relevant area
Remains current on applicable regulatory, contractual and accreditation requirements and standards; interprets regulatory, contractual and accreditation changes and assesses their impact on the relevant area
Conducts outreach to multiple department heads regarding key performance indicator (KPI) data analysis for quarterly meetings
Provides training and support to new and existing delegation oversight team members
Qualification
Required
At least 3 years of managed care experience, including at least 2 years of delegation oversight auditing experience, or equivalent combination of relevant education and experience
Ability to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required
Ability to collaborate cross-functionally across a highly matrixed organization
Strong attention to detail and organizational skills
Strong critical-thinking, and problem-solving/analytical abilities
Strong interpersonal and verbal/written communication skills
Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs
Preferred
Certified Credentialing Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Certified Clinical Coder (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in Healthcare Management (CPHM) and/or other health care certification/licensure. If licensed, license must be active and unrestricted in state of practice
Benefits
Molina Healthcare offers a competitive benefits and compensation package.
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10001+ employees
H1B Sponsorship
Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (56)
2024 (45)
2023 (43)
2022 (31)
2021 (35)
2020 (55)
Funding
Current Stage
Public CompanyTotal Funding
$2.35B2025-11-17Post Ipo Debt· $850M
2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
Leadership Team
Dave Reynolds
Executive Vice President, Health Plans & Medicaid Chief Operating Officer
Debbie Simkins
Vice President, Office of the CIO
Recent News
2026-01-16
Hartford Business Journal
2026-01-14
Sherwood News
2026-01-09
Company data provided by crunchbase