Skip to main content
Search Jobs

Let us search jobs for you based on the skills and experience listed in your LinkedIn profile.

Start Matching Jobs

Auditor Clinical Services RN Remote in California

Molina Healthcare Long Beach, California Job ID 2022461
Apply Now

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Remote position


  • 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.


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.
  • An auditor with managed care experience and healthcare experience
  • CA RN unrestricted license

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:  $26.41 - $51.49 an hour*
*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: 09/12/2023


View Map

Job Alerts

Sign up to receive automatic notices when jobs that match your interests are posted.

By uploading your resume you are not submitting an application for employment

Interested InSelect a job category from the list of options. Search for a location and select one from the list of suggestions. Finally, click “Add” to create your job alert.

  • Healthcare Services, Long Beach, California, United StatesRemove