Role Description Leads and directs team responsible for multi-state delegation oversight activities including monitoring of delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities including health plan onboarding and offboarding activities, management of oversight activities, audits and corrective action plans, issuance and service issue escalations, and ongoing risk monitoring. - In collaboration with senior leadership, sets the strategic direction for Molina’s delegation oversight responsibilities and partnerships. - Responsible for coordinating delegated vendor activities between contracted entities and Molina Healthcare; this includes claims, contact center, credentialing, appeals and grievances, care management, utilization management, pharmacy, and other operational functions across multiple states and lines of business. - Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities. - Participates in the negotiation process of delegated service level agreements (SLAs) and addendums; ensures contractual obligations are achieved, and initiates contract changes when required. - Provides assistance to strategic sourcing, national network, and health plan teams to optimize the cost-effectiveness of negotiations and ensure compliance with regulatory requirements. - Demonstrates expert review and communications of requirements related to delegated functions - ensuring clarity and minimizing change requests. - Develops, implements, and manages reporting of metrics and service level agreements (SLAs) that effectively measure team and vendor performance in line with business needs and regulatory compliance. - Demonstrates deep understanding of business and regulatory requirements, deliverables, processes, and technologies impacting delegated agreements. - Manages delegated vendor contracts as they relate to specific functions, oversees regulatory requirements, and manages related governance committees, reporting to other applicable committees (e.g., quality). - Manages delegated vendor relationships as key point of contact between specified vendors and the business. - Serves as a point of escalation for delegated vendor issues and risks - driving issues to resolution. - Optimizes delegated vendor relationships through contract management compliance, quantitative analyses, and relationship management - creating mutually beneficial opportunities. - Maintains tools related to delegation oversight relationships, including delegated vendor tracking, analytics, and performance management. - Manages the collection, consolidation, and communication of reporting and data on delegated vendor contracts, performance, risk, and relationships with key stakeholders and vendors. - Manages the performance of national and state delegated vendors to ensure compliance with contractual and regulatory requirements. - Manages the national delegation oversight performance management team. - Manages required audits for national and state delegated vendors to ensure compliance with contractual and regulatory requirements. - Manages national and state delegation oversight audit teams. - Collaborates with Molina quality department on NCQA external audits to ensure compliance with accreditation standards for applicable national and state delegated vendors. - Hires, trains, mentors, develops, and manages delegation oversight team, and demonstrates accountability for team performance. Qualifications - At least 8 years of related delegation oversight/auditing/vendor/data management experience, or equivalent combination of relevant education and experience. - At least 3 years management/leadership experience. - Ability to build relationships and manage a team. - Strong critical-thinking and problem-solving/analytical abilities. - Strong time-management, organizational, detail orientation and prioritization skills. - Strong project management skills and knowledge of project management tools/processes. - Strong data processing/analysis experience. - Ability to interpret error reports and identify remediation steps. - Ability to collaborate cross-functionally across a highly matrixed organization. - Excellent interpersonal and verbal/written communication skills. - Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs. Preferred Qualifications - Experience in Medicare and Medicaid environments. - Experience with Internal team audits and Medicare Program audits. - Experience with Power BI and Salesforce. Benefits Molina Healthcare offers a competitive benefits and compensation package. Company Description Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Role Description We are seeking a Senior GRC Specialist to own governance, risk, and compliance activities across federal IT and cybersecurity programs. This role sits at the intersection of policy, operations, and accountability, requiring someone who can manage the rigor of FISMA compliance and RMF-driven authorization programs while also keeping a sharp eye on service delivery metrics, SLA performance, and audit readiness. This is a senior individual contributor role for a practitioner who is equally comfortable drafting POA&M responses, engaging with auditors, and producing operational reporting that gives leadership clear visibility into risk and program health. What You'll Do - Own and manage POA&M lifecycle activities: tracking findings, coordinating remediation, validating closure, and maintaining accurate, audit-ready documentation. - Support FISMA compliance programs, including evidence collection, continuous monitoring, and coordination with system owners and ISSOs/ISSMs. - Apply NIST SP 800-53 and NIST SP 800-37 (RMF) to assess control implementation, support authorization activities, and maintain system security postures. - Manage and report on SLAs and availability metrics for IT and cybersecurity operations; surface trends, flag risks, and drive accountability against commitments. - Develop and maintain operational reporting for internal leadership and government stakeholders — translating compliance and operational data into clear, actionable insight. - Lead audit readiness activities: preparing teams and documentation for internal reviews, independent assessments (3PAO/IA), and government audits. - Identify gaps in control implementation or operational processes and recommend practical, risk-informed mitigation strategies. - Support continuous monitoring programs and contribute to ongoing ATO/cATO sustainment. Qualifications - Bachelor's degree in Information Technology, Cybersecurity, Information Systems, or a related field, with 6+ years of relevant experience; equivalent combination of education and demonstrated experience considered. - Active Top Secret (TS) clearance required; candidates without an active TS clearance will not be considered; sponsorship is not available for this role. - U.S. citizenship required, must be located in the US. - Demonstrated experience supporting FISMA compliance programs in federal environments. - Working knowledge of NIST SP 800-53 (control families, implementation, and assessment). - Working knowledge of NIST SP 800-37 (Risk Management Framework) and the ATO/authorization process. - Hands-on experience managing POA&M lifecycle: tracking, remediation coordination, evidence validation, and closure. - Experience preparing for and supporting federal audits and security assessments, including evidence packaging, stakeholder coordination, and finding response. - Experience managing SLAs and availability metrics in IT service delivery or cybersecurity operations environments. - Ability to develop and maintain operational reporting that communicates performance and risk posture to technical and executive audiences. - Experience producing clear, accurate reporting on cybersecurity operations, compliance status, and service health for government and internal stakeholders. Desired Qualifications - Experience with eMASS or similar GRC/authorization tracking platforms. - Familiarity with continuous monitoring (ConMon) program management and reporting. - Experience working alongside ISSOs, ISSMs, and Authorizing Officials in the RMF process. - Knowledge of FedRAMP, DoD CC SRG, or agency-specific overlays (e.g., HHS, DoD, DHS). - Experience with ITSM platforms (ServiceNow, Jira) for tracking findings and operational workflows. - Relevant certifications: CISSP, CISM, CAP/CGRC, Security+, or equivalent. Benefits - Premium health care plans (90% employer-paid). - Employee stock plan. - 100% 401k match (up to IRS annual max). - Generous PTO package. - Personal training and development budget.

• Support delivery and monitoring of the Quality Strategy, ensuring progress against objectives, KPIs and CQC domains. • Monitor quality improvement action plans, tracking milestones, evidence, risks and escalating issues where required. • Analyse quality and compliance data to identify trends, risks and opportunities for service improvement. • Lead and coordinate CQC inspection readiness, including self-assessments, evidence collation and regulatory action plans. • Maintain knowledge of the CQC mental health assessment framework to ensure ongoing regulatory compliance. • Produce and coordinate Quality Accounts, assurance reports and governance updates. • Collate and interpret information from clinical audit, Internal Review and Risk Registers to support assurance reporting. • Provide regular progress updates and assurance reports to senior leaders and governance committees. • Work collaboratively with clinical and operational teams to ensure action plans are SMART, evidence-based and effectively implemented.

Title:Program Integrity Clinical Compliance Auditor Location: United States Job Description: This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Program Integrity Clinical Compliance Auditor will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings. The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims, and medical and administrative records, to gather and analyze all necessary information to determine whether subject adhered to state and federal compliance policies, reimbursement policies, and contract compliance. The Sr. Recovery Resolution Analyst will present and discuss audit findings with client and input information into Optum audit workflow tools and the client's case tracking system. Where applicable, the Auditor will support appeal and fraud investigation activities. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule. Primary Responsibilities: - Review medical and administrative records for audit/compliance review - Travel to provider sites up to 25%/month to collect records and engage with providers - Present and participate in discussions with the client regarding audit observations and findings - Collaborate with a team of 2-5 auditors to complete reviews - Enter audit findings data and notes in online/electronic platform using Excel-based templates - Attend and participate in dispute reviews and administrative hearings - Demonstrated written and verbal communications skills - Demonstrated customer service skills You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - High School Diploma / GED OR equivalent work experience - Must be 18 years of age OR older - Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts - Must have a Valid Driver's license - 2+ years of experience reviewing health care documentation in a clinical or administrative role - Experience with MS Office Suite, specifically Word, PowerPoint, and Excel (including familiarity with basic formulas and data analysis) - Ability to travel up to 25% of the time within the state of Massachusetts as business needs dictate - Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications: - Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health - Experience in claim processing, healthcare provider information, and healthcare billing practices - Experience working in a remote/telecommute workspace - Working knowledge of medical terminology and claim coding with familiarity of CPT-4, HCPCs and ICD-10 code terminology - Familiarity with Medicaid program and/or billing requirements Telecommuting Requirements: - Reside within Massachusetts. - Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy. - Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service. *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.