Auditor, Clinical Services (Must Reside in CT)
Molina Healthcare Farmington, Connecticut Job ID 2030148KNOWLEDGE/SKILLS/ABILITIES
- 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).
- Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed.
- Assesses clinical staff regarding appropriate decision-making.
- Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
- Ensures auditing approaches follow a Molina standard in approach and tool use.
- Assists in preparation for regulatory audits by performing file review and preparation.
- Participates in regulatory audits as subject matter expert and fulfilling different audit team roles as required by management.
- 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.
- Meets minimum production standards.
- May conduct staff trainings as needed.
- Communicates with QA supervisor/manager about issues identified and works collaboratively to resolve/correct them.
JOB QUALIFICATIONS
Required 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.
Required Experience
- Minimum two years UM, CM, MAT, HM, DM, and/or managed care experience.
- Proficient knowledge of Molina workflows.
- Required License, Certification, Association
- Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.
- Active and unrestricted license in good standing as applicable.
- Preferred Experience
- 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.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $29.05 - $56.64 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 02/26/2025ABOUT OUR LOCATION
View Map- Sr Data Analyst Arizona, Kearney Nebraska, Ohio, Fort Worth Texas, Austin Texas, Orem Utah, Wisconsin, Boise Idaho, Las Cruces New Mexico, Santa Fe New Mexico, Buffalo New York, Texas, Tacoma Washington, Spokane Washington, Green Bay Wisconsin, Milwaukee Wisconsin, Iowa City Iowa, Louisville Kentucky, Bellevue Nebraska, Lincoln Nebraska, Columbus Ohio, Salt Lake City Utah, Layton Utah, Madison Wisconsin, Chandler Arizona, Cedar Rapids Iowa, Sterling Heights Michigan, Omaha Nebraska, Syracuse New York, Akron Ohio, San Antonio Texas, Utah, Racine Wisconsin, Miami Florida, Macon Georgia, Savannah Georgia, Des Moines Iowa, Iowa, Idaho, Lexington-Fayette Kentucky, Covington Kentucky, Warren Michigan, Grand Island Nebraska, Roswell New Mexico, New York New York, Kenosha Wisconsin, Jacksonville Florida, Georgia, Columbus Georgia, Augusta Georgia, Sioux City Iowa, Nampa Idaho, Idaho Falls Idaho, Kentucky, Detroit Michigan, Rio Rancho New Mexico, Yonkers New York, Cleveland Ohio, Cincinnati Ohio, Provo Utah, Vancouver Washington, West Valley City Utah, Bellevue Washington, Mesa Arizona, Ann Arbor Michigan, Nebraska, New Mexico, Albuquerque New Mexico, New York, Seattle Washington, Washington, Tucson Arizona, Phoenix Arizona, Scottsdale Arizona, Orlando Florida, Tampa Florida, Atlanta Georgia, Davenport Iowa, Caldwell Idaho, Bowling Green Kentucky, Rochester New York, Dayton Ohio, Dallas Texas, Houston Texas, Florida, St. Petersburg Florida, Meridian Idaho, Owensboro Kentucky, Michigan, Grand Rapids Michigan 03/11/2025
- Program Manager, HCS (Remote) Arizona, Salt Lake City Utah, Dallas Texas, Atlanta Georgia, Idaho Falls Idaho, Sioux City Iowa, Louisville Kentucky, Racine Wisconsin, Caldwell Idaho, San Antonio Texas, Orlando Florida, Texas, St. Petersburg Florida, Layton Utah, Columbus Georgia, Houston Texas, Nampa Idaho, Jacksonville Florida, Miami Florida, Spokane Washington, Omaha Nebraska, Bellevue Washington, Scottsdale Arizona, Phoenix Arizona, Roswell New Mexico, Macon Georgia, Georgia, Meridian Idaho, Covington Kentucky, New Mexico, Detroit Michigan, Rochester New York, Buffalo New York, Provo Utah, Yonkers New York, Florida, Columbus Ohio, Washington, Sterling Heights Michigan, Grand Rapids Michigan, Iowa City Iowa, Lincoln Nebraska, Nebraska, Davenport Iowa, Chandler Arizona, Rio Rancho New Mexico, Kenosha Wisconsin, Milwaukee Wisconsin, New York, New York New York, Dayton Ohio, Vancouver Washington, Orem Utah, Owensboro Kentucky, Bellevue Nebraska, Wisconsin, Cedar Rapids Iowa, Santa Fe New Mexico, Savannah Georgia, Akron Ohio, Austin Texas, Fort Worth Texas, Seattle Washington, Augusta Georgia, Boise Idaho, Cincinnati Ohio, Warren Michigan, Kearney Nebraska, Las Cruces New Mexico, Tucson Arizona, Utah, Syracuse New York, Idaho, Tampa Florida, Bowling Green Kentucky, Grand Island Nebraska, Albuquerque New Mexico, Iowa, Madison Wisconsin, Des Moines Iowa, West Valley City Utah, Tacoma Washington, Cleveland Ohio, Lexington-Fayette Kentucky, Ann Arbor Michigan, Kentucky, Michigan, Mesa Arizona, Green Bay Wisconsin, Ohio 02/14/2025
- Sr Accountant - REMOTE Arizona, Provo Utah, Layton Utah, Wisconsin, Tucson Arizona, Orlando Florida, Macon Georgia, Davenport Iowa, Bowling Green Kentucky, Salt Lake City Utah, Albuquerque New Mexico, Las Cruces New Mexico, Grand Rapids Michigan, Yonkers New York, Ohio, Utah, Miami Florida, Sioux City Iowa, Caldwell Idaho, Covington Kentucky, West Valley City Utah, Omaha Nebraska, Georgia, San Antonio Texas, Des Moines Iowa, Akron Ohio, Columbus Georgia, Bellevue Washington, Mesa Arizona, Florida, Detroit Michigan, Racine Wisconsin, Jacksonville Florida, Augusta Georgia, Dallas Texas, New York, Cedar Rapids Iowa, Scottsdale Arizona, St. Petersburg Florida, Houston Texas, New York New York, Orem Utah, Tacoma Washington, Warren Michigan, Savannah Georgia, Idaho, Nebraska, New Mexico, Kearney Nebraska, Milwaukee Wisconsin, Nampa Idaho, Grand Island Nebraska, Green Bay Wisconsin, Kentucky, Rio Rancho New Mexico, Phoenix Arizona, Buffalo New York, Bellevue Nebraska, Meridian Idaho, Rochester New York, Cincinnati Ohio, Spokane Washington, Chandler Arizona, Texas, Cleveland Ohio, Lexington-Fayette Kentucky, Lincoln Nebraska, Columbus Ohio, Syracuse New York, Madison Wisconsin, Fort Worth Texas, Iowa, Tampa Florida, Iowa City Iowa, Roswell New Mexico, Santa Fe New Mexico, Dayton Ohio, Sterling Heights Michigan, Austin Texas, Louisville Kentucky, Seattle Washington, Vancouver Washington, Owensboro Kentucky, Michigan, Boise Idaho, Kenosha Wisconsin, Atlanta Georgia, Idaho Falls Idaho, Ann Arbor Michigan, Washington 01/17/2025
- Sr Data Analyst - SQL & Databricks Arizona, Sioux City Iowa, Bowling Green Kentucky, Cleveland Ohio, Akron Ohio, Spokane Washington, Orem Utah, Green Bay Wisconsin, Mesa Arizona, Tampa Florida, Orlando Florida, Cedar Rapids Iowa, Idaho, Owensboro Kentucky, Warren Michigan, Covington Kentucky, Grand Rapids Michigan, Las Cruces New Mexico, Layton Utah, Jacksonville Florida, Caldwell Idaho, Florida, New Mexico, Detroit Michigan, Ann Arbor Michigan, Rio Rancho New Mexico, Buffalo New York, San Antonio Texas, Bellevue Washington, Kenosha Wisconsin, Savannah Georgia, Utah, Iowa City Iowa, Lexington-Fayette Kentucky, Lincoln Nebraska, New York New York, Columbus Ohio, Houston Texas, Milwaukee Wisconsin, Scottsdale Arizona, New York, Washington, Seattle Washington, Sterling Heights Michigan, Bellevue Nebraska, Rochester New York, Cincinnati Ohio, Fort Worth Texas, Austin Texas, Augusta Georgia, Macon Georgia, Nampa Idaho, Michigan, Wisconsin, Albuquerque New Mexico, Yonkers New York, Syracuse New York, Vancouver Washington, Racine Wisconsin, Tucson Arizona, Columbus Georgia, Georgia, Nebraska, Kentucky, Ohio, Louisville Kentucky, Omaha Nebraska, Roswell New Mexico, Dayton Ohio, West Valley City Utah, Phoenix Arizona, Chandler Arizona 01/24/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs