LTSS Audit Lead — Health & Safety Risk & Quality Oversight

Molina Healthcare, Inc.; Wauwatosa (WI); On-site; USD 120,000 - 160,000; Full time

Job summary

Molina Healthcare is seeking an experienced senior audit leader to oversee non-clinical and clinical LTSS audits, risk assessment activities and intervention effectiveness. You will drive risk-based audit priorities, collaborate across Quality, Care Management, Utilization, and Member Health and Safety functions, and deliver actionable findings to senior leaders.

The role emphasizes safeguarding member health and safety, improving processes, and aligning audits with organizational strategy for

Qualifications

• 7+ years of healthcare experience including care management and LTSS oversight.
• 1+ year of healthcare management/leadership experience.
• RN/LVN/LPN or LCSW/LMFT/LPCC/LMSW license as required by state.
• Experience developing or managing risk-based audit, monitoring, or quality review programs.
• Ability to analyze data from multiple sources and identify patterns.
• Strong analytics, problem-solving abilities and communication skills.
• Strong organizational and time-management skills and attention to detail.
• Ability to build relationships and collaborate cross-functionally.
• Proficiency with Microsoft Office or equivalent software.

Responsibilities

• Leads LTSS audit team focused on member health and safety, including residential placements, HCBS, planning, and care management.
• Establishes a risk-focused audit program with sampling plans, thresholds, review cadence, and escalation criteria.
• Directs audits of risk identification, mitigation, documentation, follow-up, and monitoring of effectiveness.
• Ensures audit findings distinguish isolated corrections from recurring process or system risks.
• Aggregates findings across units to identify patterns not visible in a single record or data source.
• Develops reporting, dashboards, and trend analyses on health and safety indicators and corrective actions.
• Translates audit results into actionable recommendations and monitors implementation with leaders.
• Presents risk findings, trends, and status to executives with due dates, owners, and evidence of completion.

Skills

Leadership

Analytics

Time management

Communication

Attention to detail

Cross-functional collaboration

Confidentiality

Office software proficiency

Education

Bachelor's degree in healthcare field

Clinical licensure/certification (as required by state)

Tools

Microsoft Office

Job description

Molina Healthcare is seeking an experienced senior audit leader to oversee non-clinical and clinical LTSS audits, risk assessment activities and intervention effectiveness. You will drive risk-based audit priorities, collaborate across Quality, Care Management, Utilization, and Member Health and Safety functions, and deliver actionable findings to senior leaders.

The role emphasizes safeguarding member health and safety, improving processes, and aligning audits with organizational strategy for