Lead Auditor, Delegation Oversight (Pharmacy - PBM)

Job Description

Job Summary

The Lead Auditor, Delegation Oversight is responsible for leading and managing the auditing of complex and multi-delegated high-risk vendors. Brings all best practices together to management for review and approval.

Scope for this position will include

• Performing audits of complex and multi-delegated high-risk vendors compliance programs, fraud/waste/abuse programs, HIPAA and financial solvency.

• Works daily with the Senior Auditor, Delegation Oversight - Pharmacy overseeing their work auditing and overseeing the PBM.

• Interfacing with other Departments, specifically Pharmacy as related to the oversight, ongoing monitoring and auditing of the PBM.

• Representing Delegation Oversight in regulatory external audits on matters related to pharmacy benefit manager oversight and auditing.

• Possible travel related to required onsite auditing and regulatory external audits.

Job Duties

• Manages regulatory and contractual change management process ensuring that all auditing tools, documents, policies, and procedures incorporate and comply with State, Federal, NCQA and any other applicable requirements. Assists in standardization and improving auditing best practices.

• Leads, prepares, and coordinates delegation oversight document evidence for external accreditation and regulatory audits.

• Oversees, tracks, and monitors Corrective Action Plans for National and State delegates for the auditing and oversight team.

• Prepares and submits reports to Delegation Oversight Committees, Quality Improvement Committees regarding National and State delegate performance and compliance.

• Creates, schedules and documents staff training to ensure auditors are trained on updates to internal processes and/or regulatory requirements.

• Perform annual oversight audits of delegated entities, provides audit findings and results according to designated timelines.

• Presents audit findings and makes recommendations to management for improvements based on audit results.

• Conducts focused audits on subcontractors, as applicable.

• Complete all mandatory compliance training annually or as required by leadership.

Job Qualifications

REQUIRED EDUCATION :

Bachelor's Degree or equivalent, combination of education and experience

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

• 5 years related auditing experience

• Strong relationship building and management experience

• Ability to manage multiple stakeholders and competing priorities

• Excellent communication skills, time management, organizational and prioritization skills

• Strong project management skills and knowledge of project management tools/processes

• Detail oriented and organized

• Excellent verbal and written communication skills

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: $54,373.27 - $117,808.76 / ANNUAL

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