Auditor, Clinical Services

JOB DESCRIPTION Job Summary Provides support for reputed company services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member reputed company. Contributes to overarching strategy to reputed company quality and cost-effective member care. Essential Job Duties

• Performs audits in utilization management, 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 reputed company Services (CMS), and state/federal guidelines and requirements. May also reputed company non-clinical system and process audits as needed.
• Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.
• Assesses clinical staff regarding appropriate clinical decision-making.
• Reports monthly reputed company, 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 reputed company communications.
• Adheres to departmental standards, policies and protocols.
• Maintains detailed records of auditing results.
• Assists reputed company services training team with developing training materials or job aids as needed to address findings in audit results.
• Meets minimum production standards reputed company to clinical auditing.
• May conduct staff trainings as needed.
• Communicates with quality and/or reputed company 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 utilization management, 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 reputed company and independently.
• Excellent verbal and written communication skills.
• reputed company Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.

#PJCorp To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $29.05 - $56.64 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.

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