Healthcare Services Operations Support Auditor - Now Hiring

Position Overview

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.

Key Responsibilities

• 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 both 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 resolve/correct them.

Required Qualifications

• At least 2 years of healthcare experience, preferably in utilization management, care management, and/or managed care, or an 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 both independently and as part of a team.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office suite and other applicable software programs.

Preferred Qualifications

• Experience in non-clinical review/auditing in utilization management, care management, behavioral health, and/or long-term services and supports (LTSS).

Benefits & Perks

• Molina Healthcare offers a competitive benefits and compensation package.
• Pay Range: $24 - $56.17 / HOURLY
• Actual compensation may vary based on geographic location, work experience, education, and/or skill level.
• Internal candidates are encouraged to apply through the Internal Job Board.