Auditor, Clinical Services (RN) Remote, Multiple Locations
2032408 Columbus, Ohio; Grand Island, Nebraska; Macon, Georgia; Albuquerque, New Mexico; Las Cruces, New Mexico; Grand Rapids, Michigan; West Valley City, Utah; Savannah, Georgia; Sioux City, Iowa; Albany, New York; Caldwell, Idaho; Tampa, Florida; Warren, Michigan; Kearney, Nebraska; Atlanta, Georgia; Miami, Florida; Nebraska; Kentucky; New Mexico; Lincoln, Nebraska; Iowa City, Iowa; Orlando, Florida; Salt Lake City, Utah; Sterling Heights, Michigan; Augusta, Georgia; Idaho; Iowa; Utah; Layton, Utah; St. Petersburg, Florida; Provo, Utah; Everett, Washington; Detroit, Michigan; Houston, Texas; Austin, Texas; Chandler, Arizona; Kenosha, Wisconsin; Rio Rancho, New Mexico; Des Moines, Iowa; Roswell, New Mexico; New York; Dayton, Ohio; Cleveland, Ohio; Omaha, Nebraska; Racine, Wisconsin; Idaho Falls, Idaho; Vancouver, Washington; Spokane, Washington; Mesa, Arizona; Fort Worth, Texas; Yonkers, New York; Texas; Michigan; Ohio; Akron, Ohio; Madison, Wisconsin; Boise, Idaho; Nampa, Idaho; Milwaukee, Wisconsin; Scottsdale, Arizona; Meridian, Idaho; Tucson, Arizona; Cedar Rapids, Iowa; Wisconsin; Santa Fe, New Mexico; Phoenix, Arizona; Orem, Utah; Tacoma, Washington; Covington, Kentucky; Davenport, Iowa; Bellevue, Nebraska; Lexington-Fayette, Kentucky; Louisville, Kentucky; Columbus, Georgia; Washington; Bowling Green, Kentucky; Owensboro, Kentucky; Bellevue, Washington; Dallas, Texas; Rochester, New York; Georgia; Florida; Jacksonville, Florida; San Antonio, Texas; Syracuse, New York; Buffalo, New York; Green Bay, Wisconsin; Ann Arbor, Michigan; Cincinnati, Ohio We are seeking a candidate with an RN licensure. The candidate must have strong organization, communication, attention to detail and time management skills. Previous medical audit experience is a bonus. This position requires the ability to work in a high-volume environment auditing the staff. Remote position Work hours: Monday - Friday: 8:00am to 4:30pm OR 8:30am to 5:00pm KNOWLEDGE/SKILLS/ABILITIES
- Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM).
- Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed.
- Assesses clinical staff regarding appropriate decision-making.
- Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Assists in preparation for regulatory audits by performing file review and preparation.
- Participates in regulatory audits as subject matter expert and fulfilling different audit team roles as required by management.
- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications.
- Adheres to departmental standards, policies, protocols.
- Maintains detailed records of auditing results.
- Assists HCS training team with developing training materials or job aids as needed to address findings in audit results.
- Meets minimum production standards.
- May conduct staff trainings as needed.
- Communicates with QA supervisor/manager about issues identified and works collaboratively to resolve/correct them.
JOB QUALIFICATIONS Required Education Completion of an accredited Registered Nurse (RN) Program and Associate's or bachelor’s degree in Nursing OR Bachelor's or master’s degree in social science, psychology, gerontology, public health, social work, or related field. Required Experience
- Minimum two years UM, CM, MAT, HM, DM, and/or managed care experience.
- Proficient knowledge of Molina workflows.
- Required License, Certification, Association
- Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
- Active and unrestricted license in good standing as applicable.
- Preferred Experience
- 3-5 years of experience in case management, disease management or utilization management in managed care, medical or behavioral health settings.
- Two years of clinical auditing/review experience.
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: $26.41 - $61.79 / HOURLY
- Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Job Type: Full Time Apply Job! Apply to this Job