RN Clinical Services Auditor (Anywhere in Washington State)
Company: Molina Healthcare
Location: Long Beach
Posted on: January 12, 2021
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Job Description:
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 Required
Experience Minimum two years UM, CM, MAT, HM, DM, and/or managed
care experience. Auditing/Clinical Review experience Required
License, Certification, Association Active and unrestricted
Washington RN 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. Proficient knowledge of Molina workflows. 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.
Keywords: Molina Healthcare, Long Beach , RN Clinical Services Auditor (Anywhere in Washington State), Other , Long Beach, California
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