Auditor, Clinical Services (RN) Remote

Lensa - Provo, UT

Job Title: Auditor, Clinical Services (RN) Remote

Position: Auditing Staff in Utilization Management and Related Areas

Job Type: Remote

Pay: $26.41 - $61.79 / HOURLY

Shift: Monday - Friday: 8:00am to 4:30pm OR 8:30am to 5:00pm

Work Type: Remote

Location

Address:

City: Provo

State: UT

ZIP Code:

Job Responsibilities

Perform 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).
Monitor key clinical staff for compliance with NCQA, CMS, State and Federal requirements.
Perform non-clinical system and process audits, as needed.
Assess clinical staff regarding appropriate decision-making.
Report monthly outcomes, identify areas of re-training for staff, and communicate findings to leadership.
Ensure that auditing approaches follow Molina standards in approach and tool use.
Assist in preparation for regulatory audits by performing file review and preparation.
Participate in regulatory audits as 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 as needed to address findings in audit results.
Meet minimum production standards.
Conduct staff trainings as needed.
Communicate with QA supervisor/manager about issues identified and work collaboratively to resolve/correct them.

Required Skills

Core Skills

Strong organization skills
Excellent communication skills
Attention to detail
Time management skills

Preferred Skills

Previous medical audit experience
Proficient knowledge of Molina workflows

Requirements

Experience: Minimum two years of experience in UM, CM, MAT, HM, DM, and/or managed care.

Education: Completion of an accredited Registered Nurse (RN) Program and Associate's or bachelor’s degree in Nursing OR Bachelor's or master’s degree in social science, psychology, gerontology, public health, social work, or related field.

License & Certification: