LTSS Quality & Risk Auditor

Molina Healthcare, Inc.

Wauwatosa (WI)

On-site

USD 65,000 - 90,000

Full time

5 days ago

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Job summary

Molina Healthcare, Inc. is seeking an Audit Specialist to perform risk-focused LTSS and HCBS audits, analyzing care management records and related data to identify health and safety risks. You will document findings, support corrective actions, and escalate issues as needed.

The role emphasizes cross-functional collaboration, data-driven decision making, and adherence to Molina standards and HIPAA regulations. Strong analytical skills and attention to detail are essential.

Qualifications

3+ years of healthcare experience in care management, utilization management, and/or managed care.
Experience analyzing data, reports, or audit results to identify trends and opportunities for improvement.
Strong analytical and problem-solving skills; keen attention to detail.

Responsibilities

Audit care management records, LTSS, HCBS, and related documentation for risk indicators.
Identify trends and risks across care delivery and settings; ensure timely escalation.
Validate data quality and trace findings to source documentation; prepare leadership reports.
Maintain HIPAA confidentiality and Molina standards in all communications and records.
Assist with staff training and development based on audit findings.