Job Description
JOB DESCRIPTION Job Summary
Provides senior level audit support for delegation oversight activities. Responsible for ensuring delegates are complaint with the applicable state, federal, contractual requirements, National Committee for Quality Assurance (NCQA), and Molina requirements for the health plan(s) they support. Identifies risk and non-compliance, issues corrective action, and actively manages the corrective action process to completion reducing and managing Molina’s risk.
**Essential Job Duties**
• 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.
• L...
Provides senior level audit support for delegation oversight activities. Responsible for ensuring delegates are complaint with the applicable state, federal, contractual requirements, National Committee for Quality Assurance (NCQA), and Molina requirements for the health plan(s) they support. Identifies risk and non-compliance, issues corrective action, and actively manages the corrective action process to completion reducing and managing Molina’s risk.
**Essential Job Duties**
• 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.
• L...