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Sr Specialist, Delegation Oversight (Claims Auditor)

Long Beach, California Job ID 1903730
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Job Description

Job Summary
Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program.

• Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
• Prepares status reports from Delegated Entities. Develops corrective action plans when deficiencies are identified, and documents follow-up to completion. Ensures compliance with reporting requirements by tracking the receipt and completeness of reports.
• Develops corrective action plans when compliance issues are identified, and document follow-up to completion.
• Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions.
• Works with Network Management team to develop and maintain delegation agreements and assessment tools.
• Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team.


Job Qualifications

Required Education
Bachelor's Degree or equivalent combination of education and experience.
Required Experience
• 3+ years managed care experience.
• Min. 1 year experience completing delegation oversight assessment/ audits.
• Data analysis experience.
Required License, Certification, Association
Valid State Driver's License
Preferred Education
Bachelor's Degree in Business or Health Care related field.
Preferred Experience
• 5 years managed care experience.
• 2 years experience completing delegation oversight assessments/audits.
• Quality management/regulatory experience with increasing responsibility.
Preferred License, Certification, Association

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.


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