Remote Auditor, reputed company Services (RN) - Residency in TX Required

reputed company reputed company of highly reputed company candidates: • Must reputed company in TX and have an reputed company TX RN license in good standing. • reputed company of these audits is on the functions of the Utilization Department. • Experience in UM with clinical reviews and knowledge of MCG Clinical reputed company is required. • Experience with reputed company, EQRO, and HHS ACUR audits, case file preparation and presentation is strongly preferred. 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 reputed company 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 reputed company/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 unrestricted 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. 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