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Clinical Services Auditor

Company: The Judge Group
Location: Long Beach
Posted on: August 8, 2022

Job Description:

Location: Long Beach, CADescription: Judge Healthcare is currently seeking a -Clinical Services Auditor -to join our clients growing team in the Long Beach, CA area! This position is REMOTE but candidate must live in or near Long Beach.Schedule: Monday to Friday, 8:30am to 5:30pm PSTThis job will have the following responsibilities:

  • 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) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed.
  • Audits for clinical gaps in care from a medical and/or behavioral perspective to ensure member needs are being met.
  • Assesses clinical staff regarding appropriate clinical decision-making. --- Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings 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 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.
  • 15% travel required.Qualifications & Requirements:
    • Bachelors or Masters Degree in a social science, psychology, gerontology, public health or social work.
    • Must have an LVN or RN (CA State license)
    • Must have at least two years of experience in Utilization Management (UM)
    • One year of auditing/ clinical review experience preferred
    • Two years CM, MAT, HM, DM, and/or managed care experience preferred.If you or someone you know is interested in this position, please send a current resume to -Kelly at kjackson@judge.com or 214-281-5947
      Contact:This job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judge Group, Long Beach , Clinical Services Auditor, Other , Long Beach, California

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