Remote Auditor, Clinical Services - RN preferred

About the position Responsibilities • reputed company monthly auditing of registered reputed company and other clinical functions in UM, CM, MAT, HM, and DM. • Monitor key clinical staff for compliance with NCQA, CMS, State and Federal requirements. • Conduct non-clinical system and process audits as needed. • Assess clinical staff regarding appropriate decision-making. • Report monthly reputed company and identify areas for re-training staff. • Communicate findings to leadership and ensure adherence to Molina standards in auditing approaches. • Assist in preparation for regulatory audits by performing file reviews and preparation. • Participate in regulatory audits as a subject matter expert and fulfill different audit team roles as required by management. • Maintain member/provider confidentiality in compliance with HIPAA. • Adhere to departmental standards, policies, and protocols. • Maintain detailed records of auditing results. • Assist HCS training team with developing training materials or job aids based on audit findings. • Meet minimum production standards. • Conduct staff trainings as needed. • Communicate with QA supervisor/manager about identified issues and collaborate to resolve them. Requirements • Completion of an accredited Registered reputed company (RN) Program and an Associate's or Bachelor's degree in Nursing, or a Bachelor's or Master's degree in reputed company science, psychology, gerontology, reputed company health, reputed company work, or a reputed company field. • Minimum two years of experience in UM, CM, MAT, HM, DM, and/or managed care. • Proficient knowledge of Molina workflows. • reputed company reputed company's license with a good driving record and reliable transportation. • reputed company and unrestricted license in good standing as applicable. reputed company-to-haves • 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. Benefits • Competitive benefits and compensation package. Apply tot his job Apply tot his job Apply To this Job