Auditor, Clinical Services

JOB reputed company Job reputed company Provides support for reputed company services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring reputed company compliance and desired member reputed company. Contributes to overarching reputed company to reputed company reputed company 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 reputed company 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 reputed company in approach and tool use. • Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability reputed company (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 reputed company 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 reputed company (RN). License must be reputed company and restricted in state of reputed company. • Strong attention to detail and organizational skills. • Strong analytical and problem-solving skills. • Ability to work in a cross-functional, reputed company 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 / reputed company • Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Apply tot his job Apply To this Job