Clinical Services Auditor Remote based in WA state

The Clinical Services Auditor performs auditing of clinical staff in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed.

This position will be supporting our Washington State Plan. We are seeking a candidate previous experience in case management within a MCO preferred, knowledge of NCQA standards for case management, and understanding of state Medicaid contracts. The Auditor should have the ability to reference/ remember rules, standards, policy procedure language and can search for the most current versions of these documents were they are housed. Proficient technology experience and experience using CCA, QNXT, Epic, PRISM, IPRO SalesForce, UMK2, and Microsoft Office and Teams programs is highly preferred. Must be able to work independently in a high-volume environment, be detail-oriented, a self-starter, and manage work time wisely. Further details to be discussed during our interview process.

Remote position in WA state. 

Work hours: Monday-Friday: 8:00AM - 5:00PM PST 

KNOWLEDGE/SKILLS/ABILITIES

• Reports outcomes, identifies areas of re-training for staff, and communicates findings leadership.

• Ensures auditing approaches follow a Molina standard in approach and tool use.

• 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 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 and/or HCS supervisor/manager about issues identified and works collaboratively to resolve/correct them.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Min. High School Diploma or GED

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

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.

PREFERRED EXPERIENCE:

More than one year managed care experience.  One year of UM, CM, DM, LTSS auditing 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: $21.82 - $48.94 / 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.