Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska

Job Summary

This position offers remote work flexibility, but the selected candidate must reside in Nebraska.

Essential Job Duties

• Performs audits in care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements.
• Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.
• Audits clinical staff regarding appropriate clinical 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.
• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications.
• Adheres to departmental standards, policies and protocols.
• Maintains detailed records of auditing results.
• Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results.
• Maintains minimum production standards related to clinical auditing.
• May conduct staff trainings as needed.
• Communicates with quality and/or healthcare services leadership regarding issues identified and works collaboratively to subsequently resolve/correct.

Required Qualifications

• At least 2 years health care experience, with at least 1 year experience in care management, and/or managed care, or equivalent combination of relevant education and experience.
• Registered Nurse (RN). License must be active and restricted in state of practice.
• Strong attention to detail and organizational skills.
• Strong analytical and problem-solving skills.
• Ability to work in a cross-functional, professional environment.
• Ability to work on a team and independently.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

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.

Pay Range

$27.59 - $56.63 / HOUR

Benefits & Compensation

Molina Healthcare offers a competitive benefits and compensation package.

Equal Opportunity Employer

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.