JOB DESCRIPTION

　　EMPLOYEE FOR THIS JOB POSITION MUST RESIDE IN CALIFORNIA.

　　Job Summary

　　Responsible for the oversight and monitoring of entities delegated for claims compliance. This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities. Oversees delegated activities to ensure compliance primarily with DMHC, DHCS, Federal and State Regulatory requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program. Responsible for continuous quality improvements within the Delegation Oversight Department. Assures compliance to external specifications and standards. Conducts comprehensive regulatory reviews using a standard audit model.

　　KNOWLEDGE/SKILLS/ABILITIES

　　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.

　　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

　　Experience with Medi-Cal and Medicare claims processing and/or auditing.

　　5 years managed care experience.

　　2 years’ experience completing delegation oversight assessments/audits.

　　Quality management/regulatory experience with increasing responsibility.

　　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.

　　Pay Range: $40,851.44 - $88,511.46 / ANNUAL

　　*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.